How To Use CPT Code 63042

CPT 63042 describes the procedure of laminotomy (hemilaminectomy) with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, reexploration, in a single lumbar interspace. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 63042?

CPT 63042 is used to describe a specific surgical procedure called laminotomy, which involves the removal of a portion of the lamina (the bony structure that covers the spinal canal) in the lumbar region. This procedure is performed to decompress the nerve root(s) and may also include partial facetectomy (removal of part of the facet joint), foraminotomy (enlargement of the neural foramen), and/or excision of a herniated intervertebral disc. It is important to note that this procedure is a reexploration, meaning it is performed after a previous surgery in the same area.

2. Official Description

The official description of CPT code 63042 is: ‘Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar.’

3. Procedure

1. The surgeon begins by making an incision in the patient’s back, specifically targeting the lumbar region.
2. The upper and lower portions of the laminae surrounding the affected vertebral interspace are removed, creating a small opening known as a laminotomy.
3. The surgeon then decompresses the nerve root(s) by removing any structures that may be compressing them, such as a herniated intervertebral disc.
4. If necessary, the surgeon may also perform a partial facetectomy to further alleviate pressure on the nerve root(s).
5. A foraminotomy may be performed to enlarge the neural foramen, the opening through which the nerve root(s) exit the spinal canal.
6. After completing the necessary decompression and other procedures, the surgeon reexplores the area to ensure that all necessary steps have been taken.

4. Qualifying circumstances

CPT 63042 is typically performed on patients who have already undergone a previous surgery in the lumbar region and require further intervention. The procedure is indicated when there is a need to decompress the nerve root(s) and alleviate symptoms caused by compression, such as pain, numbness, or weakness. The specific qualifying circumstances may vary depending on the patient’s individual condition and the surgeon’s assessment.

5. When to use CPT code 63042

CPT code 63042 should be used when a surgeon performs a laminotomy with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, as a reexploration procedure in a single lumbar interspace. It is important to accurately document the details of the procedure to support the use of this specific CPT code.

6. Documentation requirements

To support a claim for CPT code 63042, the surgeon must document the following information:

• Patient’s diagnosis and the need for reexploration and decompression of nerve root(s)
• Specific details of the procedure performed, including the level of the lumbar interspace
• Any additional procedures performed, such as partial facetectomy, foraminotomy, or excision of herniated intervertebral disc
• Date of the surgery
• Any complications or unexpected findings during the procedure
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT code 63042, it is important to ensure that the documentation supports the use of this specific code. The procedure should be performed as a reexploration in a single lumbar interspace, with decompression of nerve root(s), partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc. Modifier 50 should be appended to the code if the procedure is performed bilaterally. It is also important to follow payer guidelines and policies regarding the reporting of this code.

8. Historical information

CPT code 63042 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been a few changes to the code, including updates to the description and the addition of modifiers for bilateral procedures.

9. Examples

1. A patient who previously underwent lumbar surgery presents with persistent symptoms of nerve root compression. The surgeon performs a laminotomy with decompression of the nerve root(s), partial facetectomy, foraminotomy, and excision of a herniated intervertebral disc in a single lumbar interspace.