AHA Coding Clinic® for HCPCS - 2012 Issue 3; Ask the Editor

High Definition Monitored Transforaminal Endoscopic Discectomy

A patient at our facility underwent a transforaminal endoscopic discectomy. The surgeon states that with sequential dilators, he dilated down to the foramen with a tubular retractor. A series of reamers and/or drill are utilized to remove the ventral portion of the superior articulating process and expose the traversing nerve root. At this point the discectomy with direct visualization of the existing and traversing nerve roots on a high definition (HD) monitor is performed. The procedure is essentially an ultra-minimally invasive microdiscectomy and foraminotomy, but instead of using a microscope, the procedure is visualized in HD with an endoscope. It has been suggested that CPT code 63056 is assigned for far lateral herniated discs and CPT code 63030 for the central-paracentral herniated lumbar discs. What are the correct code assignment(s) for this procedure? ...

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