Medicare Benefits Schedule - Item 51015

Search Results for Item 51015

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Category 3 - THERAPEUTIC PROCEDURES

51015

51015 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2024

Group
T8 - Surgical Operations
Subgroup
17 - Spinal Surgery

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, more than 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51014 applies (H) 

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $3,815.50 Benefit: 75% = $2,861.65

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.141

Application of items 51011 to 51171 (Sub-group 17)

Spinal surgery items 51011 to 51171 cannot be performed in conjunction with any other item (outside of subgroup 17) in Group T8 of the MBS (surgical operation items 30001 to 50952), when that surgical item is related to spinal surgery. Items 50600 to 50644 - spine surgery for scoliosis and kyphosis in paediatric patients - are excepted from this rule when claimed in conjunction with items 51113 and 51114.

 

Meaning of Motion Segment

Motion segment is defined as including all anatomical structures (including traversing and exiting nerve roots) between and including the top of the pedicle above to the bottom of the pedicle below.

 

Combined Anterior and Posterior Surgery

Combined anterior/ posterior surgery items 51061, 51062, 51063, 51064, 51065 and 51066 cannot be claimed with any item between 51020 and 51045 (i.e. items for spinal instrumentation, posterior bone graft and/or anterior column fusion).

 

Spinal instrumentation

Spinal instrumentation items 51021 to 51026 cannot be claimed for vertebral body tethering for the treatment of scoliosis. Medicare benefits are not payable for this procedure.

Full clinical details should be documented in the patient notes, including the number of motion segments fused, which demonstrates the clinical need for the service, as this may be subject to audit.

 

Interpretation of Lumbar Spinal Fusion

Lumbar spinal fusion may not be claimed for chronic low back pain for which a diagnosis has not been made.

Related Items: 51011 51012 51013 51014 51015 51020 51021 51022 51023 51024 51025 51026 51031 51032 51033 51034 51035 51036 51041 51042 51043 51044 51045 51051 51052 51053 51054 51055 51056 51057 51058 51059 51061 51062 51063 51064 51065 51066 51071 51072 51073 51102 51103 51110 51111 51112 51113 51114 51115 51120 51130 51131 51140 51141 51145 51150 51160 51165 51170 51171

Category 3 - THERAPEUTIC PROCEDURES

TN.8.142

Spinal Decompression - Items 51011 to 51015

Items 51011 to 51015 are for services which include discectomy, decompression of central spinal canal by laminectomy or partial corpectomy (vertebral spurs and osteophytes; less than 50% of the vertebral body), and decompression of the subfacetal recess, the exit foramen and far lateral (intertransverse) space. 

Items 51011 to 51015 should only be used for direct decompression, and not where decompression occurs as an indirect result of the procedure performed. Direct decompression enables the cord and exiting nerve roots to be visualised, and the neural structures decompressed.

Through the anterior approach to the cervical spine, direct decompression can be performed with the resection of the annulus and posterior longitudinal ligament (PLL) and/or uncovertebral joints, the removal of herniated nucleus pulposa (HNP) or osteophytes. In the anterior lumbar interbody space, direct decompression can occur with resection of the posterior annulus and PLL, and removal of the HNP or osteophytes to visualise the cauda equina and decompress the neural structures.

With XLIF and OLIF, decompression can only be indirect.

For decompression procedures, only one item is selected from 51011 to 51015.

For posterolateral spinal fusion without instrumentation, if a decompression procedure is combined with the fusion, two items numbers can be selected: one from 51011 to 51015 and one from 51031 to 51036.

For posterolateral spinal fusion with instrumentation, two item numbers can be selected: one from 51020 to 51026 and one from 51031 to 51036. If decompression is also performed, three items can be selected: one from 51011 to 51015, one from 51020 to 51026 and one from 51031 to 51036.

For instrumented spinal fusion with interbody and posterolateral bone graft (with or without cages) and decompression, four item numbers can be selected: one from one from 51011 to 51015, one from 51020 to 51026, one from 51031 to 51036 and one from 51041 to 51045.

If more than 50% of a vertebral body is resected (piecemeal vertebrectomy) an item from 51051 to 51059 can be selected in addition to an item from 51011 to 51015.

Items 51011 to 51015 can be used when the purpose of the laminectomy is exposure or posterior spinal release.

Related Items: 51011 51012 51013 51014 51015


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change