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Spinal Surgery Coding Challenge: Is Hemilaminectomy Bundled With Fusion?

Posted on 21. Aug, 2009 by in Coding Challenge, Hot Coding Topics

Question: Our orthopedic surgeon turned in a note that says, “Performed a bilateral hemilaminectomy with discectomy and foraminotomy for nerve decompression.Then I did a lumbar decompression with posterior lumbar interbody fusion and posterior lateral transverse fusion with pedicular screws.”

How should I report this? Is the hemilaminectomy bundled with the fusion?

Answer: No, you shouldn’t consider the hemilaminectomy with decompression part of the fusion (although more payers are beginning to bundle these procedures).

To report both, your physician must document he decompressed the spinal cord and/or nerve roots Report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) for this part of the surgery. Be sure to append modifier 50 (Bilateral procedure) to indicate that the hemilaminectomy was bilateral.

Next, report the posterior lumbar interbody fusion (PLIF), in which the vertebral endplates are...

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