Posterior Cervical Laminectomy

CPT 63015 · 20.33 wRVU · 90-day global

CPT63015

wRVU20.33

Global90-day

ApproachOpen

ComplexityComplex

Add-on / Variant CPTs

63001 wRVU: 17.17 — Alternative primary — cervical laminectomy without facetectomy/foraminotomy, 1-2 segments (17.17 wRVU, 90-day global)
63045 wRVU: 17.5 — Alternative primary — cervical laminectomy WITH facetectomy AND foraminotomy, single segment (17.50 wRVU, 90-day global); requires all three components; add +63048 (3.38 wRVU) for each additional level
63020 wRVU: 14.54 — Alternative primary — laminotomy/foraminotomy, single cervical level only, for radiculopathy (14.54 wRVU, 90-day global) — keyhole posterior approach; use instead of 63045 when full laminectomy is not performed
63050 wRVU: 21.46 — Alternative primary — cervical laminoplasty, 2+ segments (21.46 wRVU, 90-day global)
63051 wRVU: 24.87 — Alternative primary — cervical laminoplasty with reconstruction, bridging graft, and non-segmental fixation/mini-plates (24.87 wRVU, 90-day global); includes mini-plate instrumentation — do NOT additionally bill 22842 or 22600
22600 wRVU: 16.97 — Posterior cervical arthrodesis, single vertebral segment (16.97 wRVU, add-on when fusion performed) — bill per segment, not per interspace; add +22614 for each additional segment
22614 wRVU: 6.27 — Posterior cervical arthrodesis, each additional vertebral segment (6.27 wRVU, add-on to 22600)
22842 wRVU: 12.25 — Posterior segmental instrumentation, 3-6 vertebral segments (e.g., C3-C6 lateral mass screws; 12.25 wRVU, add-on) — use for segmental constructs; 22840 (12.21 wRVU) for non-segmental fixation (wire/cable) only

Preoperative Diagnosis:

Cervical stenosis with myelopathy / cervical radiculopathy

Postoperative Diagnosis:

Same

Procedure Performed:

Posterior cervical laminectomy [C3-C6 / specify levels] [with / without] instrumented fusion

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/Fellow/PA name]

Anesthesia:

General endotracheal

Indications:

Patient presents with [cervical myelopathy / multilevel radiculopathy] refractory to conservative management. MRI demonstrates [multilevel stenosis / OPLL / hypertrophied ligamentum flavum] at [C3-C6 / specify]. T2 signal change in cord at [level]. Cervical alignment [lordotic / neutral / kyphotic — fusion required if kyphotic]. [SSEP/MEP] baselines established. Risks including infection, CSF leak, neurological deterioration, C5 nerve root palsy (5-11% incidence with laminectomy+fusion), hardware failure, adjacent segment disease, and post-laminectomy kyphosis (if fusion not performed) discussed. Consent obtained.

Findings:

Midline posterior approach to the cervical spine. Laminae identified from [C3-C6]. Ligamentum flavum hypertrophied at [levels]. Dura decompressed after laminectomy. Pulsatile dural movement confirmed at completion.

Description of Procedure:

The patient was positioned prone in Mayfield 3-pin fixation after induction. Neuromonitoring baselines recorded. Lateral fluoroscopy confirmed appropriate cervical alignment. The posterior neck was prepped and draped in sterile fashion.

A midline longitudinal incision was made from [C2 to C7]. Subperiosteal dissection of the paraspinal muscles was carried bilaterally to the lateral masses. Self-retaining retractors placed. Fluoroscopy confirmed levels. The spinous processes were removed with Leksell rongeur. The laminae were thinned with a high-speed drill and removed using Kerrison rongeurs bilaterally from [C3-C6]. Ligamentum flavum was sharply removed. The dura was decompressed and pulsatile motion confirmed.

[Bilateral foraminotomies were performed at [C5-6 / levels] using 2-mm Kerrison rongeur to address foraminal stenosis.]

[For instrumented fusion:] Lateral mass screws were placed bilaterally at [C3-C6] using the An technique. Rod cut to length and secured. Bone graft applied to decorticated lateral masses. Fluoroscopic confirmation of hardware position.

The wound was irrigated copiously. Muscle and fascia closed in layers. Skin closed with staples. Cervical collar applied. Patient tolerated the procedure well.

Complications:

None

Specimens:

Ligamentum flavum [/ bone fragment to pathology if indicated]

Estimated Blood Loss:

[X] mL

Drains:

[Wound drain placed / None]

Disposition:

Patient extubated in OR. Taken to neurosurgical ICU/floor in stable condition.

Epic SmartPhrase Version

PREOPERATIVE DIAGNOSIS: Cervical stenosis with [myelopathy / radiculopathy], ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Posterior cervical laminectomy, ***, [with / without] instrumented fusion
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with cervical [myelopathy / multilevel radiculopathy] refractory to conservative management. MRI demonstrates multilevel stenosis / OPLL / hypertrophied ligamentum flavum at ***. T2 cord signal change at ***. SSEP/MEP baselines established. Risks including infection, CSF leak, neurological deterioration, hardware failure, and post-laminectomy kyphosis were discussed. Informed consent obtained.

FINDINGS: Posterior cervical spine exposed *** to ***. Ligamentum flavum hypertrophied at [levels]. After laminectomy, dura decompressed with pulsatile dural movement confirmed. [Foraminotomies performed at ***.]

DESCRIPTION OF PROCEDURE:
Patient positioned prone in Mayfield 3-pin fixation. Neuromonitoring baselines recorded. Lateral fluoroscopy confirmed cervical alignment. Midline incision from *** to ***. Subperiosteal dissection bilaterally to lateral masses. Self-retaining retractors placed. Fluoroscopy confirmed levels. Spinous processes removed with Leksell rongeur. Laminae thinned with high-speed drill and removed with Kerrison rongeurs from ***. Ligamentum flavum sharply excised. Dural pulsatility confirmed. [Bilateral foraminotomies at *** with 2-mm Kerrison.] [Instrumented fusion: lateral mass screws placed bilaterally at *** using An technique; rod secured; bone graft applied to decorticated lateral masses; fluoroscopic confirmation.] Wound irrigated. Muscle and fascia closed in layers. Skin closed with staples. Cervical collar applied. Neuromonitoring stable throughout. Patient tolerated the procedure well.

ESTIMATED BLOOD LOSS: *** mL
SPECIMENS: Ligamentum flavum [/ bone fragment if indicated]
COMPLICATIONS: None
DRAINS: [Wound drain / None]
DISPOSITION: Patient extubated in OR. Taken to neurosurgical ICU/floor in stable condition.

Signed: .ME, .MYDEGREE
.TODAY

Variants

Laminoplasty (open-door or French-door)

Motion-preserving alternative. Requires lordotic or neutral alignment — contraindicated with >13 degrees of kyphosis or significant preoperative axial neck pain. CPT 63050 (laminoplasty, 2+ segments, 21.46 wRVU) or 63051 (with mini-plate reconstruction; 24.87 wRVU). Open-door (Hirabayashi) technique: lamina completely cut on open side, greenstick fracture hinge on contralateral side (one hinge). French-door (Kurokawa) technique: midline spinous process split with bilateral hinges at the lamina-facet junction (two hinges). Document which technique, hinge side for open-door, opening size, mini-plate fixation, and whether graft placed in the gutter.

Laminotomy/foraminotomy only

For single-level foraminal stenosis causing radiculopathy, without global central stenosis. CPT 63020 (laminotomy with nerve root decompression, single cervical level; 14.54 wRVU, 90-day global) — do NOT use 63045, which requires full laminectomy plus facetectomy plus foraminotomy. Document hemilaminotomy, medial facetectomy extent, and nerve root decompression confirmed. Add +63035 for each additional cervical level if performed bilaterally or multilevel.

Charting Tips

State exact levels decompressed — this is the CPT-determining element (63001 for 1-2 segments, 63015 for >2 segments, 63045 per-level if facetectomy/foraminotomy at each level)
Bilateral foraminotomies or unilateral: document each level; any foraminal decompression beyond central laminectomy supports 63045+63048 coding rather than 63015 for that level
Note ligamentum flavum removal and dural pulsatility as markers of adequate decompression
{'Document cervical alignment': 'lordotic alignment maintained (laminoplasty and laminectomy-alone require lordosis; fusion locks in alignment, good or bad)'}
If fusion added, document lateral mass screw technique (An, Magerl, or Roy-Camille — specify which) and rod construct; document bilateral vs. unilateral
Document neuromonitoring baseline and any intraoperative signal changes — MEP/SSEP changes require immediate documentation and response protocol
{'C5 palsy (5-11% with laminectomy+fusion)': 'document baseline deltoid and biceps strength preoperatively; any new postoperative weakness should be charted against this baseline'}

Billing Tips

For central decompression only (no facetectomy/foraminotomy), bill 63001 (1-2 cervical segments, 17.17 wRVU, 90-day global) or 63015 (>2 cervical segments, 20.33 wRVU) — a single code covers all levels decompressed. 63045 (17.50 wRVU) requires full laminectomy PLUS facetectomy PLUS foraminotomy at a single segment and is NOT appropriate for multi-level central decompression alone. When 63045 is used (with facetectomy and foraminotomy), add-on +63048 (3.38 wRVU per level) applies for each additional level — but 63048 can only be added to 63045/63046/63047 and cannot be appended to 63001/63015.
For single-level posterior laminoforaminotomy only (keyhole posterior approach for radiculopathy, without full laminectomy), bill 63020 (14.54 wRVU, 90-day global). This is the correct code for a hemilaminotomy, medial facetectomy, and nerve root decompression — not 63045.
Laminoplasty: bill 63050 (cervical laminoplasty, 2+ segments; 21.46 wRVU) or 63051 (with reconstruction, bridging graft, and non-segmental fixation/mini-plates; 24.87 wRVU). 63051 includes mini-plate instrumentation — do NOT additionally bill 22840/22842 or 22600/22614 for the same levels as laminoplasty.
When posterior fusion is added, bill the fusion code in addition to the decompression code. They are not bundled. Primary fusion code: 22600 (posterior cervical arthrodesis, single segment, 16.97 wRVU) + +22614 (each additional segment, 6.27 wRVU). Instrumentation: +22842 (segmental fixation, 3-6 levels, e.g., C3-C6 lateral mass screws; 12.25 wRVU) or 22840 (non-segmental, e.g., sublaminar wire). For C3-C6 lateral mass screw constructs (bilateral pedicle/lateral mass screws at each level), use 22842 — not 22840.
90-day global period: physical therapy, collar management, and routine wound checks are bundled. IONM is billed by the monitoring provider (not the surgeon) using 95940 (in-room) or G0453 (Medicare remote). Any MEP/SSEP changes must be documented in real time in the operative note.

General coding reference. Verify with your institution’s billing department before submitting claims.

ⓘ General Billing Tips →