2025 CPT code 63012
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Lumbar laminectomy with removal of abnormal facets and/or pars interarticularis, with decompression of cauda equina and nerve roots for spondylolisthesis.
Modifiers may apply based on specific circumstances, such as multiple levels, significant additional work, or other related services. Refer to CPT and payer guidelines for appropriate modifier usage.
Medical necessity is established by the presence of documented symptoms (pain, neurological deficits) directly attributable to spondylolisthesis with significant nerve root compression, unresponsive to conservative treatment options.Clear documentation of the failed conservative care attempt is crucial.
The surgeon's responsibilities include making an incision, carefully retracting soft tissues and muscles to visualize the spine, removing the specified portions of the lamina, facets, or pars interarticularis, and ensuring decompression of the nerve roots and cauda equina.Postoperative care and follow-up are also part of the clinical responsibility.
In simple words: This surgery removes part of the bone in the lower back to relieve pressure on the nerves.It's done for a condition called spondylolisthesis, where one vertebra slips over another, pinching nerves and causing pain. The goal is to reduce pain and improve nerve function.
This procedure involves a lumbar laminectomy, where a portion or all of the lamina (bony arch of the vertebra) is removed to relieve pressure on the cauda equina and nerve roots.Abnormal facets and/or pars interarticularis (part of the vertebra) may also be removed during this decompression procedure, which is specifically indicated for spondylolisthesis (forward slippage of one vertebra over another). The procedure aims to alleviate nerve compression and associated symptoms.
Example 1: A 60-year-old patient presents with severe lower back pain, leg weakness, and numbness due to spondylolisthesis at L4-L5. A 63012 is performed to decompress the affected nerve roots., A 45-year-old patient experiences significant lower back pain and radiculopathy (nerve pain radiating to the leg) due to severe spondylolisthesis involving L5-S1.The surgeon performs a 63012 with removal of significant bone spurs., A 72-year-old patient with a history of trauma exhibits chronic lower back pain and neurological symptoms consistent with spondylolisthesis at L3-L4. After conservative measures fail, a 63012 is performed with associated discectomy.
Preoperative imaging (X-rays, MRI, CT scans) showing spondylolisthesis and nerve root compression.Operative report detailing the extent of the laminectomy, removal of facets/pars interarticularis, and decompression achieved.Postoperative neurological exam documenting improvement in symptoms.Discharge instructions and follow-up plan.
** Accurate coding requires comprehensive documentation of the procedure, including the level(s) of the spine involved, specific structures resected, and the extent of decompression achieved.Consider possible additional codes for concomitant procedures.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information requires accessing specific payment rate databases and may vary by payer and location. Consult appropriate resources for RVU data, CMS conversion factors, and reimbursement details.
- Global Days: Global period details require consultation of specific payer policies and may vary.Check with your payer for specifics.
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier may be applicable depending on the specific circumstances and payer guidelines.
- Fee Schedule: Historical fee schedule data is not readily available in this context and requires access to specific fee schedules for each payer and relevant time period.
- Specialties:Orthopedic Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center