How To Use HCPCS Code C9757

HCPCS code C9757 describes a specific surgical procedure known as laminotomy (hemilaminectomy) with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of a herniated intervertebral disc. This procedure also involves the repair of an annular defect with the implantation of a bone anchored annular closure device. It is typically performed in the lumbar region of the spine, specifically in one interspace.

1. What is HCPCS C9757?

HCPCS code C9757 is a specific code used to identify the surgical procedure described above. It is important for medical coders to accurately assign this code when billing for the procedure to ensure proper reimbursement and documentation.

2. Official Description

The official description of HCPCS code C9757 is as follows: “Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar.” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The procedure begins with the surgeon making an incision in the patient’s back, specifically in the lumbar region.
2. The surgeon then performs a laminotomy, which involves removing a portion of the lamina, a bony structure that covers the spinal canal.
3. Next, the surgeon decompresses the nerve root(s) by removing any tissue or bone that may be compressing them.
4. During the procedure, the surgeon also performs a partial facetectomy, which involves removing a portion of the facet joint to provide additional space for the nerve root(s).
5. A foraminotomy is then performed to enlarge the neural foramen, the opening through which the nerve root(s) exit the spinal canal.
6. The surgeon also excises a herniated intervertebral disc, which involves removing the portion of the disc that is protruding and causing compression on the nerve root(s).
7. Finally, the surgeon repairs an annular defect, which is a tear or hole in the outer layer of the intervertebral disc, using a bone anchored annular closure device. This device helps to seal the defect and prevent further herniation of the disc.
8. Throughout the procedure, the surgeon uses image guidance to ensure accurate placement of the implants and to assess the measurement, alignment, and sizing of the annular defect.

4. When to use HCPCS code C9757

HCPCS code C9757 should be used when the specific surgical procedure described in the official description is performed. It is important to review the medical documentation and ensure that all components of the procedure are documented in order to accurately assign this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9757, healthcare providers should ensure that the medical documentation supports the performance of all the components of the procedure, including the laminotomy, decompression of nerve root(s), partial facetectomy, foraminotomy, excision of herniated intervertebral disc, and repair of annular defect with implantation of a bone anchored annular closure device. Additionally, the documentation should include details of the annular defect measurement, alignment and sizing assessment, and the use of image guidance. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9757 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code C9757 is covered by Medicare. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Healthcare providers should review the specific coverage guidelines of other insurance carriers to determine if this code is payable.

8. Examples

Here are five examples of when HCPCS code C9757 should be billed:

1. A patient presents with severe lower back pain and radiating leg pain. Imaging studies reveal a herniated intervertebral disc in the lumbar region. The surgeon performs a laminotomy with decompression of the nerve root(s), partial facetectomy, foraminotomy, excision of the herniated disc, and repair of the annular defect using a bone anchored annular closure device.
2. A patient with a history of lumbar disc herniation experiences a recurrence of symptoms. The surgeon performs a repeat laminotomy with decompression of the nerve root(s), partial facetectomy, foraminotomy, excision of the herniated disc, and repair of the annular defect using a bone anchored annular closure device.
3. A patient with a known annular defect in the lumbar region undergoes a laminotomy with decompression of the nerve root(s), partial facetectomy, foraminotomy, excision of the herniated disc, and repair of the annular defect using a bone anchored annular closure device.
4. A patient with a history of failed conservative treatment for a lumbar disc herniation undergoes a laminotomy with decompression of the nerve root(s), partial facetectomy, foraminotomy, excision of the herniated disc, and repair of the annular defect using a bone anchored annular closure device.
5. A patient with a known annular defect and persistent lower back pain undergoes a laminotomy with decompression of the nerve root(s), partial facetectomy, foraminotomy, excision of the herniated disc, and repair of the annular defect using a bone anchored annular closure device.