Quiz #1: Lumbar Stenosis

Spinal stenosis is a narrowing of the spaces within the spine, which can put pressure on the spinal cord, cauda equina, and/or nerve roots.  This condition is often an age-related. However, patients who suffer a spinal injury or who are born with narrow canal syndrome may also suffer from this condition.

Knowledge and understanding of the individual segments of the vertebrae is very important because these details are necessary for accurate coding in both diagnoses and procedures.

Diagnosis: Lumbar stenosis of the L4-L5 interspace
1. L4-5 laminectomies, medial facetectomies, foraminotomies for decompression
2. L4-5 posterolateral fusion with local bone graft
Which CPT codes would be used for this procedure?
22612, 63047-51 and 20936
Correct: A single-level posterolateral fusion (22612) with autograft (20936) was performed with a decompression for stenosis (63047). Modifier 51 is appended to the lower-valued code (63047). There are no bundling issues.
22612, 63047-51, 63048 and 20936
Incorrect: 63048 is an add-on code for each additional insterspace.
22630, 63047-59 and 20936
Incorrect: Modifier 59: Distinct Procedural Service would not be used as the procedures are located at the same site.
22630, 63005 and 20936
Incorrect: A posterolateral technique was used (22612), not a posterior interbody technique (22630). Additionally, facetectomies and foraminotomies were performed, eliminating 63005.

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