63005 vs. 63047

Question:

Help me understand the difference between 63005 and 63047 – I don’t get it! The codes look the same to me.

Answer:

Yes, it can be confusing because the code descriptions are very similar. However, look very carefully and you’ll see the differences. Here are the code descriptions and I’ve bolded some key differences:

CPT Code	Description
63005	Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis
63047	Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)), single vertebral segment; lumbar

CPT 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord. CPT 63047 involves not only removal of lamina for central decompression but also lateral recess decompression in the form of a facetectomy (e.g., medial, partial) and/or foraminotomy for nerve root decompression.

*This response is based on the best information available as of 08/27/15.

ICD-10: Procedural Coding System vs. CPT Codes

Question:

Now that ICD-10 is going to happen I’m starting to look into it a bit more. I see there is a procedural coding system component. Are we going to have to use that instead of, or in addition to, CPT?

Answer:

Good Question:. The ICD-10 procedural coding system (ICD-10-PCS) is used by facilities (e.g., hospital) to code procedures. CPT codes are, and will continue to be, used by physicians (and other providers) to report professional services. The two systems are unique and very different. You will not be using ICD-10-PCS to report professional services; rather, you will continue to use CPT codes. You will, however, be changing from ICD-9-CM (ICD-9 Clinical Modification) diagnosis codes to ICD-10-CM diagnosis codes on October 1, 2015 for claims submitted to HIPAA-covered entities. So the good news is that the CPT coding system is not changing for physicians – only the diagnosis coding system will be different.

*This response is based on the best information available as of 04/23/15.

TLIF

Question:

I have an operative report where the neurosurgeon performed L5-S1 minimal invasive transforaminal lumbar interbody fusion (TLIF) with L5/S1 and an instrumented fusion (pedicle screws/rods). He did a far lateral transforaminal approach to disc space with left L5/S1 facetectomy and discectomy. He also placed a PEEK cage for the interbody arthrodesis packed with morselized allograft and autograft.

The surgeon gave the following codes: 63056, 63047, 22325, 22630, 22840, 22851, 20931 and 20936. Also, anytime we bill 22325 with 63047 the code gets denied. Is a modifier 59 appropriate on 22325? I’m not sure why 63047 always denies as inclusive. I’m also Question:ing code 63056 with 22630 – I’m not sure the two should be billed together. Can you help, please?

Answer:

Sure – there are a couple of issues here. First, you’re right – 63047 and 22325 should not be billed together for procedures performed at the same level. The fracture repair code (22325) includes removing bone fragments and decompression (63047). Do not append modifier 59 to 63047 when performed at the same spinal level as 22325. That said, your description of the procedure does not support reporting either code, 22325 OR 63047.

And, you’re right – 63056 should not be billed because it is part of the approach to perform the TLIF (22630). Finally, I think you’re confusing 20931 (structural allograft) with 20930 (morselized allograft). So the correct codes are, based on your description: 22630, 22840, 22851, 20930, 20936.

*This response is based on the best information available as of 04/09/15.