Lumbar laminectomy CPT code 63030 bills for the procedure when the physician performs back surgery to relieve pressure on a nerve. Laminotomy is also known as hemilaminectomy or a partial laminectomy.
Lumbar laminectomy surgery may include removing part of a spine bone (vertebra) or a disc (cushion between the vertebra). Below are the description and billing guidelines for the 63030 CPT code for lumbar laminectomy.
What Is The Difference Between CPT 63030 And CPT 63047?
Lumbar laminectomy can be reported with CPT codes 63030 and 63047. These codes are almost the same procedure, but segment and interspace differ.
CPT code 63030 can be billed for lumbar laminectomy procedures on the interspace, and CPT code 63047 for laminectomy on segments.
A lumbar laminectomy procedure performed on a single vertebrate (e.g., L5 and L4 separately) is called a segment. And it is called interspace if the procedure is performed between the inter-space of L5 and L4.
TIP: You can find the billing guide for CPT code 63047 here.
Can CPT Codes 63030 And 63047 Be Billed Together?
If CPT 63047 performs in addition to CPT code 63030, it is inappropriate to report CPT code 63030 separately as it includes in CPT code 63047.
Reasons For A Lumbar Laminectomy Procedure
Lumbar laminectomy (CPT code 63030) intends to create more spinal canal space to relieve nerve tissue pressure and reduce pain. The following are the reasons why physicians perform a 63030 CPT code procedure:
- Spinal stenosis
- Herniated or displaced disc
- Pinched nerve
What Is CPT Code 63030?
A physician can approach a 63030 CPT code procedure using a posterior (back) by overlying the vertebrae through a midline incision. This procedure may occur through the tissue to the paravertebral muscles, which may retract.
The ligamentum flavum supports attaching the lamina from one vertebra to the lamina of another. They may remove partially or entirely during the procedure.
The patient has a ruptured disc or compressed fragments, or the part of the disc may remove to treat the pain.
They may also perform facetectomy or foraminotomy to relieve the nerve pressure. In the hemilaminectomy CPT code procedure, one vertebra’s lamina may be released on one side to access the spinal cord.
When decompression is complete during the CPT 63030 procedure, a free-fat graft may place to protect the nerve root. If the ligament flavum does not remove, it puts over the fat graft. Paravertebral muscles do reposition, and the tissue is closed in layers.
Note that approaches represented by these codes may be open laminotomy or endoscopically assisted, which still requires open and direct visualization. In an endoscopically assisted procedure, a small guide probe inserts under fluoroscopic guidance.
The physician may use fluoroscopic guidance and magnified video in CPT code 63030 when manipulating the foramen and into the spinal canal via endoscope.
Once the guide probe has advanced to the surgical site, a slightly larger tube is conducted over the guide probe.
Surgical instruments advanced through the hollow center of the tube. Herniated disc fragments remove, and the disc reconfigures to eliminate pressure on the nerve root(s) during the lumbar laminotomy procedure.
63030 CPT Code Description
CPT 63030 bills for the service when the physician performs laminotomy (hemilaminectomy) with decompression of nerve root(s), including partial foraminotomy, facetectomy, and or excision of the herniated intervertebral disc such as one interspace, lumbar region.
CPT’s manual officially describes the 63030 CPT code for lumbar laminectomy as: “Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of the herniated intervertebral disc; 1 interspace, lumbar”.
Billing Guidelines For Laminectomy Procedures
Documentation must establish the medical necessity and appropriateness of CPT code 63030. It should reflect the patient health status and the severity of illness related to laminotomy (hemilaminectomy) with decompression of one interspace of the lumbar nerve root.
The lumbar laminectomy procedure has a 90-day global period, including a 1-day preoperative and 90-day postoperative period.
The 63030 CPT code includes endoscopic assistance through open and direct visualization, and It is inappropriate to report separately.
If the physician performs arthrodesis CPT 22590 to CPT 22614 in combination with CPT code 63030, it is appropriate to report separately without any modifier assignment, according to NCCI.
If the physician performs percutaneous decompression CPT 62287, CPT 0274T, or CPT 0275T in combination with CPT code 63030, it is appropriate to report separately without any modifier assignment.
CPT code 63030 excludes laminectomy in the same session as posterior interbody fusion. Therefore, it is appropriate to report posterior interbody fusion separately.
If the physician performs decompression of nerves or spinal components CPT 63052 in combination with CPT code 63030, it is appropriate to report separately without any modifier assignment, according to NCCI.
If the physician prepares interspace CPT 22630 or CPT 22633 in combination with CPT code 63030, it is appropriate to report separately without any modifier assignment according to NCCI.
Hemi laminectomy is mainly billed as a unilateral procedure code. It is appropriate to report twice when performed bilaterally.
It is inappropriate to report CPT 63030 or CPT 63035 with CPT 22630, CPT 22632, CPT 22633, or CPT 22634 when performed to prepare the interspace for fusion for the same spinal interspace.
Report CPT 63020 if the disc is cervical; CPT 63030 if lumbar; and CPT 63035 for additional interspaces, cervical or lumbar.
Can CPT Codes 63040 And 63044 Be Billed Together?
Suppose the physician performs re-exploration laminotomy with partial facetectomy, foraminotomy, and excision of the herniated intervertebral disc. It is appropriate to report CPT 63040 to CPT 63044.
Can CPT Codes 63045 And 63048 Be Billed Together?
Suppose the physician performs laminectomy (complete excision of the lamina), unilateral or bilateral, with facetectomy and foraminotomy. It is appropriate to report with CPT 63045 to CPT 63048.
Suppose the same physician performs evaluation and management (E/M) service for a reason related to laminotomy of the lumbar region. It is inappropriate to report E/M CPT 99202 to CPT 99499 separately.
Does CPT Code 63030 Need A Modifier?
The following are the list modifiers applicable to the CPT code for lumbar laminectomy (hemilaminectomy).
Modifier 47 is applicable CPT 63030 when the surgeon administers general or regional anesthesia to the patient during laminotomy with decompression of the lumbar nerve root. Therefore, it is inappropriate to report modifier 47 with anesthesia procedures.
Modifier 76 is appropriate with the 63030 CPT code when repeat laminotomy with decompression of one lumbar nerve root service performs by the same physician on the same service date.
Modifier 54 attaches to the CPT code 63030 when the physician provides surgical care only in the laminotomy with decompression in the lumbar area.
Modifier 55 applies to the lumbar laminectomy procedure CPT code when the physician provides post-surgical care only in the laminotomy with decompression of the lumbar region.
Modifier 56 reports with the CPT code for lumbar laminectomy when the physician provides the preoperative surgical care only during the hemilaminectomy with decompression.
Modifier 77 is applicable when laminotomy with decompression of one interspace of the lumbar nerve root by a different Physician on the same day.
Report modifier 59 when the physician performs the particular service in addition to the laminotomy with decompression on the same date.
Modifier XS can be reported with CPT 63030 when the physician performs hemilaminectomy with decompression and the procedure with different anatomical regions, such as the cervical spine, instead of the lumbar area.
Report modifier XE in conjunction with CPT code 63030 when the physician performs hemilaminectomy with decompression on the distinct region in a different encounter. For instance, The patient had pain after one hemilaminectomy procedure and redo the procedure later on the same day.
Modifier XP attaches to the CPT code for hemilaminectomy when the distinct practitioner performs the hemilaminectomy with decompression on the same service date.
Modifier 53 can be reported when the physician terminates the laminotomy with decompression due to unavoidable circumstances, such as the patient’s condition becoming unstable due to an allergic reaction or hypothermia.
Bill modifier 22 with 63030 while the provider spends the additional time during the hemilaminectomy with decompression procedure. This is because the patient may start bleeding during hemilaminectomy and need extra time to stop the bleeding.
Modifier 23 is applicable when general or local anesthesia administers by the physician and routinely does not require it during the hemilaminectomy with decompression of the lumbar region.
Apply modifier 52 when the physician reduces the hemilaminectomy with decompression of the lumbar region and does not schedule in the future.
If physicians believe Medicare will deny the laminotomy with decompression, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 63030 must apply the GA modifier to that service.
A maximum of one unit can be a bill on the same service date of CPT 63030. In contrast, the Two units allow when documentation supports the medical necessity of the service.
The cost and RUVS of CPT 63030 are $1062.55 and 30.70406 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 63030 are $1062.55 and 30.70406 when enacted in the non-facility
A seventy-three-year-old male presents to the office with lumbar radiculopathy and lumbar stenosis at the L1 and L2 interspace region. The patient had severe low back pain and was restricted to home only.
The patient denies heavy vibrations, chills, abdominal pain, dizziness, cough, recent illness, fever, trauma, nausea, travel, known sick contacts, and other problems.
The patient took his routine medication for lumbar radiculopathy. The physician ordered a CT scan of the lumbar region and laboratory studies for diagnostic purposes. The physician decides to do a Laminotomy procedure at the L1 and L2 segments.
CPT code 63047 is appropriate to report this condition and does not apply to the thoracic and lumbar spine hemilaminectomy.