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AANS Coding – AMA CPT Correction

The AANS recognizes the importance of proper AMA coding. AANS strives to provide the most up-to-date, relevant information to members. The following is a recent AANS statement for your consideration regarding CPT code description updates:

In the May 2018 CPT Assistant publication, the AMA has corrected the previous inconsistency regarding the use of the decompressive laminectomy code 63047 at the same level as interbody fusion (22630 or 22633). The correction in the CPT Assistant publication says that codes 22633 and 63047 may be reported for the same interspace when additional work is required to complete a decompression at the same spinal level.

It has always been the position of AANS that CPT coding descriptions of these codes allow for reporting of 63047 at the same level as 22633 or 22630 when work for decompression of neural elements is required in addition to the work required to perform the interbody fusion. The need for decompression for clinical scenarios such as neurogenic claudication alongside the need for interbody fusion, such as instability, must be accurately documented in the operative note.

Based on this CPT Assistant publication, a -59 modifier should be added to 63047 when used with the 22633 or 22630 for non-Medicare patients.

It is important to note that there is a separate edit instituted by the National Correct Coding Initiative that prevents use of the -59 modifier in this circumstance for Medicare patients. Billing these codes at the same level in a Medicare patient with a -59 modifier is not allowed.

Applying the same CPT codes differently for operative procedures that are identical has the potential to cause confusion. The AANS Coding Courses add greater clarity to the lumbar decompression and interbody codes and other coding challenges.

June 2018