2025 CPT code 63043
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Nervous System - Spine Surgery Surgery Feed
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, re-exploration, each additional cervical interspace.
Modifier 50 (bilateral procedure) should not be appended to 63043.Report the code twice for bilateral procedures. Other modifiers may apply depending on the circumstances.
Medical necessity is established by clinical findings of nerve root compression documented through history, physical examination, and imaging.The procedure aims to alleviate neurologic symptoms caused by spinal stenosis, herniated disc, or other compressive lesions.
The clinical responsibility rests with the neurosurgeon or spine surgeon. The surgeon performs the laminotomy, decompression, facetectomy, foraminotomy, and/or disc excision.Pre- and postoperative care are also under the surgeon's purview.
In simple words: This code describes a surgery to relieve pressure on a nerve in your neck.The surgeon makes a small opening in the bone to remove pressure caused by a herniated disc or other issues. This is an additional procedure, and it’s only used if the surgeon does the main procedure on a different part of the neck.
This CPT code, 63043, represents a laminotomy (or hemilaminectomy, a partial laminectomy) of each additional cervical interspace, performed during a re-exploration.The procedure involves decompression of the nerve root(s) and may include a partial facetectomy, foraminotomy, and/or excision of a herniated intervertebral disc. It's crucial to understand that this code is an add-on code and must be reported in addition to the primary procedure code (63040). The surgeon removes the upper and lower portions of adjacent laminae, encompassing two adjacent vertebral interspaces.Even if the entire lamina is removed at adjacent levels, it's considered two hemilaminectomies if intervertebral discs are excised.
Example 1: A patient presents with cervical radiculopathy due to a herniated disc at C5-C6 and C6-C7.A cervical laminotomy is performed at C5-C6 (primary procedure 63040), and 63043 is added for the additional level at C6-C7., During a re-exploration of a prior cervical fusion, the surgeon finds significant stenosis at C4-C5 and C5-C6 requiring additional laminotomies to achieve adequate nerve root decompression. Code 63040 is used for the primary procedure and 63043 is added for each additional level., A patient undergoes cervical laminotomy for multilevel stenosis (C3-C4, C4-C5, C5-C6).The surgeon uses 63040 for the first level and 63043 for each subsequent level.
Detailed operative notes describing the procedure, including levels involved, specific techniques (partial facetectomy, foraminotomy, discectomy), and the extent of decompression.Preoperative imaging (MRI, CT) demonstrating the pathology and postoperative imaging confirming decompression.
** Always confirm payer-specific coding and billing requirements before submitting claims.This information is for guidance only and should not be considered medical advice.
- Revenue Code: P1F (Major Procedure - Explor/Decompr/ExcisDisc)
- RVU: Data not available.RVUs vary by region and payer.
- Global Days: Global period information not specified in provided data.Refer to payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: This code does not typically have a Technical Component (TC) modifier associated with it, but check payer-specific rules.
- Fee Schedule: Data not available.Refer to historical fee schedules for your specific payer and geographic region.
- Specialties:Neurosurgery, Orthopedic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center