The new year brings some welcome clarifications to the spinal discectomy and decompression codes. These changes should make it much easier to code for these types of cases.

To distinguish between these newer and revised procedure codes, it's helpful to ask 2 questions:

• Is this an open or percutaneous procedure?
• Does this procedure mainly address decompression of the vertebral components (as needed for central spinal stenosis and lateral recess stenosis) or does it mainly address decompression of the disc (as needed for a herniated disc)?

Codes 63020 through 63035
The following codes have been clarified:

• 63020 Laminectomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical
• 63030 Laminectomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar
• 63035 Each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)

The introductory guidelines for these codes have been added to the CPT Manual. They state that endoscopically assisted laminotomy requires open and direct visualization in order for you to report codes 63020 to 63035. According to the November 2010 CPT Assistant, in order to code 63020 to 63035, "... the intrinsic essential components of this code are performed; namely, a resection of the vertebral component, spinous processes, and lamina, which must include a discectomy, for decompression of the nerve root(s) ... "

To report codes 63020 to 63035, the procedure must be performed open; meaning you must document direct visualization of the surgical site, even when it is achieved through an operating microscope. You may use endoscopic visualization and imaging for assistance in addition to direct visualization, but you must document direct visualization.

Also, according to CPT Assistant, to report 63020 to 63035, a discectomy must be performed in addition to resection of a vertebral component (for example, spinous process, lamina, etc.).

Codes 63020 to 63035 are for open procedures and for decompression of the disc. In order for 63020 to 63035 to be reported, a portion of the vertebra must be resected.

Code 62287
What if the procedure is performed with an endoscope and imaging, but there is no direct visualization? What if the procedure only includes discectomy without resection of the vertebral component? That's where CPT 62287 comes into play.

62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar

This code has been revised to include the use of an endoscope and to include any discography (62290, 72295) and/or epidural injection (62311) performed at the level of the decompression.

CPT 62287 is clearly percutaneous. Also, the procedure is clearly for decompression of the disc. Codes 63020 to 63035 are similar to 62287. Both are directed toward the disc and both can include the use of an endoscope. However, these codes differ in that the endoscope used in 63020 to 63035 is for assistance and must be used in conjunction with an open approach/direct visualization. For 62287, there is no direct visualization of the site; rather, imaging or endoscopy is used to indirectly visualize the surgical site. These codes also differ in that for 63020-63035, part of the vertebra, such as the lamina, must be resected, whereas for 62287, a vertebral resection procedure is not required.

CPT 62287 is only for procedures on the lumbar spine, while codes 63020 to 63035 cover the cervical, thoracic and lumbar regions. For percutaneous nucleus pulposus of intervertebral disc decompression procedures on the cervical and thoracic spine, report the unlisted 64999. Code 62287 is coded once, regardless of how many lumbar discs are decompressed.

Codes 0274T and 0275T
Two new Category III CPT codes were added for spinal decompression on July 1, 2011:

• 0274T Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic
• 0275T Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar

Code 0275T was created for "MILD" (Minimally Invasive Lumbar Decompression) procedures and 0274T was created for similar type procedures performed on the cervical and thoracic regions. Codes 0274T and 0275T are clearly for percutaneous procedures. The surgical site is not visualized directly but via imaging guidance and/or endoscopy.

"The devices used for the MILD procedure are not intended for disc procedures, but for tissue resection at the perilaminar space within the interlaminar space, and at the ventral aspect of the lamina," according to the November 2010 CPT Assistant. "These devices are not intended for use near the lateral neural elements and remain dorsal to the dura using image guidance and anatomical landmarks."

So while the code descriptors for codes 0274T and 0275T include any discectomy performed, discectomy isn't required in order to assign these codes. These codes are mainly geared toward procedures for vertebral decompression (for example, excision of lamina, ligamentum flavum, facet, etc.).

As with code 62287, 0274T and 0275T are coded once per surgical session. For example, multiple levels of percutaneous laminectomy at the lumbar spine would be coded to 0275T only once; multiple levels of the same procedure at the cervical and/or thoracic spine would be coded to 0274T only once.

What if you perform a vertebral decompression (for example, resection of spinous process, lamina and/or ligamentum flavum), as would be needed for central canal stenosis due to ligamentous hypertrophy or lateral recess stenosis, open rather than percutaneous? Depending on the documentation, you could report codes 63045 to 63048.