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Lumbar Laminectomy CPT Code 63047 | Facetectomy And Foraminotomy | Billing Guide

Lumbar laminectomy CPT code 63047 can be reported for facetectomy or foraminotomy. The physician performs surgery to remove a portion of a vertebra (spinal bone) in the upper or lower back to relieve a pinched nerve. Below are the description and billing guidelines for the 63047 CPT code for facetectomy or foraminotomy.

What Is CPT Code 63047?

A physician performs a unilateral or bilateral laminectomy, facetectomy, or foraminotomy of a vertebral segment with decompression of the cauda equina, spinal cord, and nerve roots to treat spinal or lateral recess conditions stenosis. 

What Is The Difference Between CPT 63047 And CPT 63030?

Lumbar laminectomy can be billed with CPT 63047 and with CPT 63030. CPT 63047 and CPT 63030 are almost the same procedure, but the difference is segment and interspace.

The 63047 CPT code procedure can be billed for laminectomy on segments and the 63030 CPT code can be reported for procedures performed on the interspace.

A procedure is done on a single vertebrate (e.g., L4 separately and L5 separately) it is called a segment. If the lumbar laminectomy procedure is performed between the inter-space of L4 and L5, it is called interspace.

TIP: You can find the billing guide for CPT code 63030 here.

Lumbar Laminectomy (Facetectomy & Foraminotomy) Procedures Explained

A physician creates a midline incision overlying the impacted vertebrae and the fascia. Paravertebral muscles retract, and magnification can be used.

The physician eliminates the spinous procedures with rongeurs and the lamina from the articular facets using a burr when stenosis is present in the central region during 63047 CPT code procedures.

If the compression is present at the lateral recess, it may remove only half of the lamina. A Penfield elevator peels the ligamentum flavum away from the dura during foraminotomy.

The physician freed the nerve root canals by additional facet resection, and compression is relieved by removing any bony or tissue overgrowth around the foramen in the foraminotomy.

Removal of the lamina, facets, bony tissue, or overgrowths may perform bilateral sides when indicated. The physician removes the rongeur, retractor, and microscope during unilateral or bilateral laminectomy and is billed with CPT 63047. A free-fat graft may place over the nerve root(s) for protection. 

Paravertebral muscles reposition, and the deeper tissues and skin are closed with layered sutures. If the ligamentum flavumspares, it places over the free-fat graft.

Report CPT code 63046 if the procedure affects a thoracic vertebra report, CPT 63047 if the procedure involves a lumbar vertebra and CPT 63048 for procedures affecting each additional vertebral segment.

63047 CPT Code Description

CPT 63047 can be billed for the service when the physician performs facetectomy, laminectomy, and foraminotomy. This procedure can be unilateral or bilateral with decompression of the spinal cord, cauda equina the or nerve roots

CPT’s manual officially describes the lumbar laminectomy CPT code 63047 for facetectomy and foraminotomy as: “Laminectomy, facetectomy, and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina or/and nerve root/roots (for example, lateral or spinal or recess stenosis). Single vertebral segment; lumbar.”

How To Bill CPT Code 63047

Documentation must establish the medical necessity and appropriateness of CPT 63047. It should reflect the patient health status and the severity of illness related to the facetectomy or laminectomy of the lumbar spine.

Lumbar laminectomy CPT code 63047 has a 90-day global period, including a 1-day preoperative and 90-day postoperative period.

Endoscopic assistance through open and direct visualization is included, and it is inappropriate to report separately.

If the physician performs arthrodesis CPT 22590 to CPT 22614 in combination with CPT code 63047, it is appropriate to report foraminotomy of the lumbar region separately without any modifier assignment.

It is appropriate to laminectomy of the lumbar region separately if the physician performs percutaneous decompression of CPT 62287, CPT 0274T, and CPT 0275T in combination with the 63047 CPT code.

This procedure excludes laminectomy at the same session as posterior interbody fusion. And it is appropriate to report posterior interbody fusion separately.

If the physician performs laminectomy without facetectomy, foraminotomy, or discectomy, one or two segments, It is appropriate to report with CPT 63001 to CPT 63011 instead of the CPT code 63047.

It is appropriate to report CPT 63015 to CPT 63017 instead of CPT code 63047 if a physician performs laminectomy without facetectomy, foraminotomy, or discectomy of more than two segments.

It is inappropriate to report CPT 63047 or CPT 63048 with CPT 22630, CPT 22632, CPT 22633, or CPT 22634 when performed to prepare the interspace for fusion for the same vertebral segment and spinal interspace.

Can CPT Codes 63047 And 63052 Be Billed Together?

If the physician performs decompression of nerves or spinal components CPT 63052 in combination with CPT code 63047, it is appropriate to report separately without any modifier assignment.

Can CPT Codes 22630, 22633, And 63047 Be Billed Together?

If the physician prepares interspace CPT 22630 or CPT 22633 in combination with laminectomy CPT code 63047, it is appropriate to report separately without any modifier assignment.

Can CPT Codes 63047 And 63047 Be Billed Together?

If CPT code 63047 performs in addition to CPT code 63030, it is inappropriate to report the 63030 CPT code separately as it includes CPT code 63047. 

Can CPT Codes 63045 And 63048 Be Billed Together?

CPT 63045 to CPT 63048 bill when the physician performs laminectomy (complete excision of the lamina), with facetectomy and foraminotomy. 

Can CPT Codes 63052 And 63053 Be Billed Together?

Suppose the physician performs decompression of nerves or spinal components on the same vertebral segment. It may also conduct in interspace as the posterior interbody fusion. It is appropriate to report with CPT code 63052 or 63053.

Does CPT Code 63047 Need A Modifier?

Modifier 47 can be reported with CPT 63047 when the surgeon administers general or regional anesthesia to the patient during the laminectomy of the lumbar region.

It is inappropriate to report modifier 47 with anesthesia procedures as it only reports with this procedure.

 Modifier 76 can be billed for a lumbar laminectomy procedure when the same physician repeats the laminectomy of the lumbar region on the same service date. For instance, the patient repeats the procedure at different L4 and L5 on the same day due to no improvement in the pain.

Modifier 77 can be attached to CPT code 63047 when a different physician repeats the laminectomy of the lumbar region on the same day. 

Bill modifier 54 when a provider provides surgical care only during the laminectomy of the lumbar region.

Report CPT code 63047 with modifier 55 when the physician provides post-surgical care only during the foraminotomy of the lumbar region.

Attaches modifier 56when the physician provides pre-surgical care only during the facetectomy of the lumbar region.

Modifier 59 is applicable with the 63047 CPT code when the physician performs a particular service in addition to the foraminotomy of the lumbar region. It may bundle with another procedure and requires modifier 59 to avoid payment delays. 

Modifier XS can be attached to this procedure when the physician performs the foraminotomy of distinct structures, such as the thoracic spine, instead of the lumbar region.

Modifier XE may be applied when the physician performs the foraminotomy of the lumbar region in a discrete encounter on the same day.

You can report this code with modifier XE. For example, a patient presents for foraminotomy of L1 and L2 discs in the morning. He returns for L4 and L5 regions in a separate encounter later.

Modifier 53 can be reported with CPT 63047 when the physician terminates the foraminotomy of the lumbar region due to exceptional circumstances, such as electrical supplies issues during the procedure.

Apply modifier 22 when services perform foraminotomy of the lumbar region longer than usual and take extra resources during the procedure, such as a physician spending time to stable the patient vitals. 

Modifier 78 can be billed when the related service performs during the postoperative period due to the complication. For instance, the patient presents in the operation room with severe bleeding at the lumbar region incision foraminotomy. Therefore, CPT 63047 may bill with a modifier of 78, and it will not affect the global period of foraminotomy.

Modifier 23 is applicable with CPT code 63047 when general or local anesthesia administers by the physician during facetectomy of the lumbar region and routinely does not require it during the procedure. 

It is appropriate to report Modifier 52 when the physician reduces the foraminotomy of the lumbar region and does not reschedule the procedure in the coming days.

If physicians believe Medicare will deny facetectomy procedures, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and the CPT code for lumbar laminectomy must apply the GA modifier to that service.

Reimbursement

A maximum of one unit can be a bill on the same service date for CPT code 63047. In contrast, the Two units allow when documentation supports the medical necessity of the service.  

The cost and RUVS are $1200.39 and 34.68713 when performed in the facility. In contrast, reimbursement and RUVS are $1200.39 and 34.68713 when enacted in the non-facility.

Example 1

A fifty-three-year-old male with tumors on the lumbar region presented to the emergency department with c/o lumbar stenosis at the L2-L3 interspace region. The patient could not walk for 1-week and had severe low back pain

The patient is asked by his primary care physician and recommended to go to the emergency department. The physical exam reveals swelling in the back region and is otherwise unremarkable. The patient denies any headache, disorder of CNS, nausea, vomiting, or urinary bladder symptoms. 

The physician decides to do a Laminotomy procedure in the L4 and L5 segments. The laminotomy CPT code 63047 may be billed when the service performs in the lumbar region. However, it is inapplicable to bill for the thoracic and cervical spine. 

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