How To Use CPT Code 0274T

CPT 0274T describes a percutaneous laminotomy/laminectomy procedure performed through an interlaminar approach to decompress neural elements in the cervical or thoracic region. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0274T?

CPT 0274T can be used to describe a percutaneous laminotomy/laminectomy procedure performed through an interlaminar approach. This procedure aims to alleviate pressure on the nerve by creating more space for the nerve root to exit the spinal canal. It can be used to treat conditions such as herniated or bulging discs in the cervical or thoracic region.

2. Official Description

The official description of CPT code 0274T is: ‘Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral; cervical or thoracic.’

3. Procedure

1. The provider begins by making a small incision in the skin of the affected cervical or thoracic spinous process.
2. Using imaging guidance, the provider inserts a specially designed endoscope and obturator sheath.
3. The provider advances an obturator through the sheath along the base of the spinous process to the interlaminar space.
4. After confirming the epidural space, the provider drills the center of the superior edge of the lamina under the lesion and dissects the ligamentum flavum.
5. The provider may also perform additional procedures such as ligamentous resection, discectomy, facetectomy, or foraminotomy to decompress the herniated disc(s) at one or multiple levels.
6. For bilateral procedures, the provider repeats the steps on the opposite side of the vertebra.
7. Finally, the provider removes all equipment, controls any bleeding, and closes the wound.

4. Qualifying circumstances

CPT 0274T is typically performed on patients with herniated or bulging discs in the cervical or thoracic region. The procedure may involve ligamentous resection, discectomy, facetectomy, or foraminotomy, depending on the patient’s specific condition. It is important to note that this procedure is performed percutaneously, meaning it is done through the skin.

5. When to use CPT code 0274T

CPT code 0274T should be used when a provider performs a percutaneous laminotomy/laminectomy procedure through an interlaminar approach to decompress neural elements in the cervical or thoracic region. It is important to ensure that the procedure is performed under indirect image guidance, such as fluoroscopy or CT, and that it is done using any method, single or multiple levels, and unilateral or bilateral.

6. Documentation requirements

To support a claim for CPT 0274T, the provider must document the following information:

• Patient’s diagnosis and the need for decompression of neural elements
• Specific procedures performed, such as ligamentous resection, discectomy, facetectomy, or foraminotomy
• Method of indirect image guidance used (e.g., fluoroscopy, CT)
• Number of levels treated (single or multiple)
• Laterality of the procedure (unilateral or bilateral)
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 0274T, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed percutaneously through an interlaminar approach, under indirect image guidance, and may involve additional procedures such as ligamentous resection, discectomy, facetectomy, or foraminotomy. It is also important to follow any additional guidelines provided by payers regarding coverage and reimbursement for this procedure.

8. Historical information

CPT code 0274T was added to the Current Procedural Terminology system on January 1, 2012. It underwent a code change on January 1, 2017, which expanded the description to include the use of an endoscope and clarified the inclusion of ligamentous resection, discectomy, facetectomy, and foraminotomy.

9. Examples

1. A provider performs a percutaneous laminotomy procedure through an interlaminar approach to decompress neural elements in the cervical region of a patient with a herniated disc.
2. A patient with multiple herniated discs in the thoracic region undergoes a percutaneous laminectomy procedure through an interlaminar approach to alleviate pressure on the nerves.
3. A provider performs a percutaneous laminotomy and discectomy procedure through an interlaminar approach to decompress neural elements in the cervical region of a patient with a bulging disc.
4. A patient with a herniated disc in the thoracic region undergoes a percutaneous laminotomy and facetectomy procedure through an interlaminar approach to relieve pressure on the nerves.
5. A provider performs a percutaneous laminectomy and foraminotomy procedure through an interlaminar approach to decompress neural elements in the cervical region of a patient with multiple herniated discs.
6. A patient with a bulging disc in the thoracic region undergoes a percutaneous laminotomy, ligamentous resection, and discectomy procedure through an interlaminar approach to alleviate pressure on the nerves.
7. A provider performs a percutaneous laminectomy, facetectomy, and foraminotomy procedure through an interlaminar approach to decompress neural elements in the cervical region of a patient with a herniated disc.
8. A patient with multiple herniated discs in the thoracic region undergoes a percutaneous laminotomy and ligamentous resection procedure through an interlaminar approach to relieve pressure on the nerves.
9. A provider performs a percutaneous laminectomy, discectomy, and facetectomy procedure through an interlaminar approach to decompress neural elements in the cervical region of a patient with a bulging disc.
10. A patient with a herniated disc in the thoracic region undergoes a percutaneous laminotomy, foraminotomy, and ligamentous resection procedure through an interlaminar approach to alleviate pressure on the nerves.