DecisionHealth, DecisionHealth - 2024 Issue 1 (January)
Q&A: Select spinal decompression codes based on diagnosis, AMA states
Question: We recently read coding guidance in the AHA Coding Clinic (Q1 2023) that appears to state that spinal stenosis should no longer be used as the primary diagnosis for code 63047 and that the code can be reported for other indications. Specifically, the article describes a scenario where “the diagnosis was listed as L4-L5 lateral foraminal stenosis. The question arose as to whether, based upon the diagnosis of stenosis, would it be appropriate to report CPT code 63047, Laminectomy facetectomy, and foraminotomy (unilateral of bilateral with decompression of spinal cord, cauda equine and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; lumbar, for the procedure. The presence of “eg” in the parenthetical of code 63047 indicates this code is reported for procedures that are performed for diagnoses such as spinal stenosis or lateral recess stenosis; these conditions are only examples.
“When the description of the procedure as documented in the operative report is consistent with the code narrative for a condition such as spinal stenosis, it is appropriate to assign CPT code 63047.” Can you please clarify?
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