Codes for Laminectomy for Lumbar Radiculopathy

Question:

For a patient with a diagnosis of lumbar  radiculopathy, the surgeon performed a L3-L4 laminectomy with bilateral   foraminotomy. She also removed some disc at the same level. Can both 63047 and 63030-59 be billed?

Answer:

For a laminectomy at a single interspace/motion segment, only one code may be reported. In the case described above, the laminectomy for stenosis, 63047, is the only code reported. The disc removal is inclusive. And remember, laminectomy codes are diagnosis driven. A more specific diagnosis for the cause of the radiculopathy stenosis for example, should be added.

*This response is based on the best information available as of 07/06/23.

Venous Stenting for Intracranial Hypertension (ICH)

Question:

What are the most appropriate codes for venous stenting for a patient with intracranial hypertension?

Answer:

There is no specific CPT code for intracranial venous stenting. An unlisted code 64999 should be reported in addition to second order venous catheterization, 36012 and the venogram , most typically 75870, venography superior sagittal sinus. It is not appropriate to report a peripheral stenting code such as 37236. for an intracranial procedure. Code 61635 is also not appropriate as it is specifically for intracranial arterial stenting for a diagnosis of atherosclerosis.

*This response is based on the best information available as of 06/08/23.

Facet Fusion

Question:

The neurosurgeon documents a placing a cervical “facet implant or intrafacet implant “ with bone graft. Is this coded as 22600, cervical arthrodesis?

Answer:

No. This is coded with a Category III code, as shown below:

Facet Wedge or Dowel Arthrodesis (Intrafacet Implant)

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level

• Cervical: 0219T
• Thoracic: 0220T
• Lumbar: 0221T
• Additional level: +0222T
• Includes fluoroscopy and any radiological service.
• Includes bone graft, instrumentation and arthrodesis – do not report 0219T-0221T with +20930, +20931, 22600-22614, +22840, +22853, +22854, +22859 at the same level.

*This response is based on the best information available as of 05/25/23.

Placing Methylmethacrylate around Pedicle Screws

Question:

The surgeon placed methylmethacrylate around the pedicle screw in a spine surgery. How is this coded?

Answer:

Placing methylmethacrylate to reinforce the instrumentation is included in the spine procedure.

*This response is based on the best information available as of 05/11/23.

Laser Interstitial Thermal Therapy (LITT) Coding

Question:

When using LITT treatment, can theneuronavigationand headframe placement be billed separately?

Answer:

No, neuronavigation, 61781 and headframe placement, 20660 are included and may not be billed separately.

*This response is based on the best information available as of 04/27/23.

Laser Interstitial Thermal Therapy (LITT) Coding

Question:

I’m using LITT for epilepsy treatment.

Answer:

The codes are 61736Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion and 61737multiple trajectories for multiple or complex lesion(s)

*This response is based on the best information available as of 04/13/23.