How To Use CPT Code 63035

CPT 63035 describes a specific procedure that involves laminotomy, decompression of nerve root(s), and excision of herniated intervertebral discs. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 63035?

CPT 63035 is a code used to describe a surgical procedure known as laminotomy. This procedure involves the removal of the upper and lower portions of adjacent laminae, which are the bony structures that form the back of the vertebrae. The purpose of laminotomy is to decompress the nerve root(s) and alleviate pressure on the spinal cord. Additionally, this procedure may include a partial facetectomy, foraminotomy, and/or excision of herniated intervertebral discs. It is important to note that CPT 63035 is used for each additional cervical or lumbar interspace beyond the first, and it should be reported in conjunction with the primary procedure code.

2. Official Description

The official description of CPT code 63035 is: ‘Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure).’ This code should be used when performing laminotomy with decompression of nerve root(s) and other associated procedures on each additional cervical or lumbar interspace beyond the first.

3. Procedure

1. The surgeon begins the laminotomy procedure by making an incision in the appropriate area of the spine.
2. Using specialized surgical instruments, the surgeon removes the upper and lower portions of adjacent laminae, which are the bony structures that form the back of the vertebrae.
3. The surgeon may also perform a partial facetectomy, which involves removing a portion of the facet joint to further decompress the nerve root(s).
4. If necessary, the surgeon may perform a foraminotomy, which involves enlarging the neural foramen to relieve pressure on the nerve root(s).
5. During the procedure, the surgeon may also excise herniated intervertebral discs to alleviate compression on the nerve root(s).
6. If the laminotomy is performed on each additional cervical or lumbar interspace beyond the first, CPT code 63035 should be reported in addition to the primary procedure code.

4. Qualifying circumstances

CPT 63035 is typically performed on patients who require decompression of nerve root(s) and excision of herniated intervertebral discs. This procedure is commonly used to treat conditions such as spinal stenosis, herniated discs, and nerve root compression. It is important to note that CPT 63035 should not be reported in conjunction with certain other procedures, such as laminectomy performed to prepare the interspace for fusion on the same interspace(s) and vertebral segment(s).

5. When to use CPT code 63035

CPT code 63035 should be used when performing laminotomy with decompression of nerve root(s), partial facetectomy, foraminotomy, and/or excision of herniated intervertebral discs on each additional cervical or lumbar interspace beyond the first. It is important to accurately document the specific procedures performed and the number of interspaces treated to ensure proper coding and billing.

6. Documentation requirements

To support a claim for CPT code 63035, the surgeon must document the following information:

• Patient’s diagnosis and the need for laminotomy with decompression of nerve root(s)
• Specific procedures performed, including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral discs
• Number of interspaces treated beyond the first
• Date of the procedure
• Any additional relevant details or complications encountered during the procedure
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT code 63035, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, it is crucial to follow the appropriate coding guidelines and modifiers, if applicable. CPT code 63035 should not be reported in conjunction with certain other codes, such as those related to fusion procedures or posterior interbody fusion. It is recommended to review payer guidelines and policies to ensure accurate and compliant billing.

8. Historical information

CPT code 63035 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been several historical changes and updates to the code, including modifications to the code description and the addition of specific guidelines and notes.

9. Examples

1. A patient with spinal stenosis undergoes laminotomy with decompression of nerve root(s) and excision of herniated intervertebral discs at the L4-L5 and L5-S1 interspaces.