How To Use CPT Code 63052

CPT 63052 is a code used for laminectomy, facetectomy, or foraminotomy procedures during posterior interbody arthrodesis in the lumbar region. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 63052 procedures.

1. What is CPT 63052?

CPT 63052 is a medical billing code used to describe a specific type of spinal surgery involving laminectomy, facetectomy, or foraminotomy during posterior interbody arthrodesis in the lumbar region. This code is used by medical coders and billers to accurately document and bill for this procedure.

2. 63052 CPT code description

The official description of CPT code 63052 is: Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (List separately in addition to code for primary procedure).

3. Procedure

The 63052 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider performs laminectomy, facetectomy, or foraminotomy on a single vertebral segment for decompression during lumbar posterior interbody arthrodesis.
3. The services can be unilateral or bilateral.
4. For laminectomy, the provider excises the vertebral lamina, often referring to the removal of the posterior arch.
5. For facetectomy, the provider excises the facet joint between two vertebral bodies.
6. For foraminotomy, the provider excises bone to widen the intervertebral foramen, the bony hollow archway spinal nerves run through.
7. The provider performs nerve decompression, peeling elastic tissue (ligamentum flavum) away from the dura (spinal cord’s outer lining).
8. The provider frees the nerve root canals and relieves compression by removing any bony or tissue overgrowth around the foramen.
9. The provider completes the separately reportable lumbar posterior interbody arthrodesis, removes instruments, repositions tissues, and closes the incision in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 63052 services are those who require laminectomy, facetectomy, or foraminotomy during posterior interbody arthrodesis in the lumbar region. This may include patients with spinal or lateral recess stenosis, nerve root compression, or other conditions that necessitate decompression of the spinal cord, cauda equina, and/or nerve roots. The procedure can be performed on a single vertebral segment, either unilaterally or bilaterally.

5. When to use CPT code 63052

It is appropriate to bill the 63052 CPT code when a provider performs laminectomy, facetectomy, or foraminotomy during posterior interbody arthrodesis in the lumbar region on a single vertebral segment. This code should be used in conjunction with an appropriate primary code for the arthrodesis procedure. The 63052 code is an add-on code and should not be billed separately without a primary code.

6. Documentation requirements

To support a claim for CPT 63052, the following information should be documented:

• Indication for the procedure, including the patient’s diagnosis and medical necessity for the surgery.
• A detailed description of the procedure, including the specific type of surgery performed (laminectomy, facetectomy, or foraminotomy), the vertebral segment involved, and whether the procedure was unilateral or bilateral.
• Documentation of the separately reportable lumbar posterior interbody arthrodesis procedure, including the primary code used for billing.
• Any intraoperative findings, complications, or additional procedures performed during the surgery.
• Postoperative care instructions and follow-up plans.

7. Billing guidelines

When billing for CPT code 63052, it is important to follow the appropriate guidelines and rules. This code is an add-on code and should be reported in addition to the primary code for the lumbar posterior interbody arthrodesis procedure. Payers will not reimburse for this code unless it is reported with an appropriate primary code. Additionally, ensure that all documentation requirements are met to support the claim for CPT 63052.

8. Historical information

CPT 63052 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Similar codes to CPT 63052

Five similar codes to CPT 63052 and how they differentiate are:

1. CPT 63047: This code is used for laminectomy, facetectomy, or foraminotomy procedures in the lumbar region without posterior interbody arthrodesis.
2. CPT 63048: This code is used for each additional vertebral segment during laminectomy, facetectomy, or foraminotomy procedures in the lumbar region.
3. CPT 63056: This code is used for transpedicular approach procedures during posterior interbody arthrodesis in the lumbar region.
4. CPT 63057: This code is used for each additional vertebral segment during transpedicular approach procedures in the lumbar region.
5. CPT 22558: This code is used for lumbar posterior interbody arthrodesis procedures without laminectomy, facetectomy, or foraminotomy.

10. Examples

Here are 10 detailed examples of CPT code 63052 procedures:

1. A patient with spinal stenosis undergoes a laminectomy during lumbar posterior interbody arthrodesis at the L4-L5 level.
2. A patient with foraminal stenosis undergoes a bilateral foraminotomy during lumbar posterior interbody arthrodesis at the L3-L4 level.
3. A patient with degenerative disc disease undergoes a facetectomy during lumbar posterior interbody arthrodesis at the L5-S1 level.
4. A patient with spondylolisthesis undergoes a laminectomy and facetectomy during lumbar posterior interbody arthrodesis at the L4-L5 level.
5. A patient with lumbar radiculopathy undergoes a unilateral foraminotomy during lumbar posterior interbody arthrodesis at the L2-L3 level.
6. A patient with lumbar spinal stenosis undergoes a bilateral laminectomy during lumbar posterior interbody arthrodesis at the L3-L4 level.
7. A patient with degenerative spondylolisthesis undergoes a facetectomy during lumbar posterior interbody arthrodesis at the L4-L5 level.
8. A patient with lumbar foraminal stenosis undergoes a unilateral foraminotomy during lumbar posterior interbody arthrodesis at the L5-S1 level.
9. A patient with lumbar disc herniation undergoes a laminectomy during lumbar posterior interbody arthrodesis at the L2-L3 level.
10. A patient with lumbar facet joint arthritis undergoes a facetectomy during lumbar posterior interbody arthrodesis at the L3-L4 level.