CPT Code for Minimally Invasive Lumbar Decompression: What You Need to Know

Introduction

Minimally invasive lumbar decompression (MILD) has emerged as an effective treatment option for patients suffering from lumbar spinal stenosis. As this innovative technique gains popularity, understanding its coding and reimbursement is crucial for both healthcare providers and patients. This article delves into the CPT code for MILD, its current valuation, and the ongoing efforts to ensure fair reimbursement for this procedure.

The CPT Code for Minimally Invasive Lumbar Decompression

The Current Procedural Terminology (CPT) code assigned to minimally invasive lumbar decompression is 62380. This code was introduced on January 1, 2017, to specifically describe single-level endoscopic lumbar discectomy (Lewandrowski et al., 2024). However, it's important to note that while the code exists, it currently lacks assigned work relative value units (RVUs), which are crucial for determining reimbursement rates.

The Valuation Challenge

Despite the introduction of CPT code 62380, the current valuation does not accurately reflect the complexity and work involved in performing MILD. A study by Lewandrowski et al. (2024) found that the calculated work RVU for endoscopic lumbar decompression surgery should be 18.2464, significantly higher than the current valuation. This discrepancy has led to concerns about underreimbursement for surgeons performing the procedure.

Comparison to Other Lumbar Procedures

The study by Lewandrowski et al. also compared MILD to other common lumbar spine surgeries. Their findings suggest that the valuation for endoscopic lumbar decompression surgery should be:

• 111.1% of the laminectomy with exploration and/or decompression of spinal cord and/or cauda equina (CPT 63005)
• 118.71% of the laminectomy code (CPT 63047), which includes foraminotomy and facetectomy
• 152.1% of the hemilaminectomy code (CPT 63030)
• 259.55% of the interlaminar or interspinous process stabilization/distraction without decompression code (CPT 22869)

The Impact of Undervaluation

The current undervaluation of CPT code 62380 has significant implications for both healthcare providers and patients. Lorio et al. (2021) noted that the misvaluation of similar codes has created a supply-and-demand anomaly, where the rate of certain minimally invasive procedures has flatlined despite increasing rates of fusion procedures and an aging population. This situation could potentially limit patient access to innovative, less invasive treatment options.

Efforts to Address the Valuation Issue

Recognizing the importance of proper valuation, several spine societies have endorsed research efforts to reassess the work RVUs for minimally invasive lumbar decompression. These organizations include:

• The Interamerican Society for Minimally Invasive Spine Surgery (SICCMI)
• The Mexican Society of Spinal Surgeons (AMCICO)
• The International Society For Minimally Invasive Spine Surgery (ISMISS)
• The Brazilian Spine Society (SBC)
• The Society for Minimally Invasive Spine Surgery (SMISS)
• The Korean Minimally Invasive Spine Surgery (KOMISS)
• The International Society for the Advancement of Spine Surgery (ISASS)

The Benefits of Minimally Invasive Lumbar Decompression

Despite the coding and reimbursement challenges, it's important to recognize the benefits of MILD for patients. Deer et al. (2020) reported that MILD has demonstrated excellent efficacy and safety, with a safety profile equivalent to epidural steroid injections. The procedure offers several advantages, including:

• Minimal intraoperative blood loss
• Reduced surgical trauma to paraspinal muscles
• Ability to perform the procedure in an outpatient setting
• Faster recovery times compared to traditional open surgery

Conclusion

While CPT code 62380 exists for minimally invasive lumbar decompression, its current valuation does not accurately reflect the complexity and work involved in the procedure. Ongoing efforts by spine societies and researchers aim to address this discrepancy and ensure fair reimbursement. As the field of minimally invasive spine surgery continues to evolve, proper coding and valuation will be crucial in maintaining patient access to these innovative treatment options. Healthcare providers, payers, and policymakers must work together to align reimbursement with the true value of MILD, ultimately benefiting patients seeking relief from lumbar spinal stenosis.