Is a requested inpatient stay and cervical laminoplasty (CPT 63051) medically necessary for a patient with neck pain, cervical myelopathy, cervical spondylosis, and cervical radiculopathy?

DETERMINATION: APPROVED - OUTPATIENT PROCEDURE ONLY

The requested cervical laminoplasty (CPT 63051) is medically necessary for this patient with multilevel cervical stenosis and myelopathy, but the inpatient admission is NOT medically necessary - this procedure should be performed on an outpatient basis. 1

RATIONALE

Medical Necessity for the Procedure is Established

This 31-year-old female meets all clinical criteria for cervical laminoplasty:

• Multilevel moderate-to-severe stenosis (C3-7) with canal diameter <10mm and nadir of 7.6mm at C3-4, meeting the threshold for surgical intervention 1
• Documented myelopathy with cord flattening, possible signal changes at C5-6, balance disturbance (falls when washing hair with eyes closed), leg spasms, and history of sudden leg weakness causing falls 1, 2
• Failed conservative management with muscle relaxants and dry needling providing only temporary relief of neck pain without addressing neurologic symptoms 1, 3
• Appropriate imaging showing no significant instability (≤2mm motion on flexion/extension films) and no kyphosis, which are prerequisites for laminoplasty 1

Outpatient Setting is Appropriate and Guideline-Recommended

Multiple high-quality studies demonstrate that posterior cervical decompression procedures, including laminoplasty, are safely performed on an outpatient basis with excellent outcomes. 1

• A prospective case series of 183 patients with cervical radiculopathy underwent laminoforaminotomy on an outpatient basis in all cases with 93% good-to-excellent outcomes and zero immediate readmissions 1
• The mean hospital stay for percutaneous multilevel cervical decompression and fusion was only 5.7 days even with instrumented fusion, suggesting that decompression alone requires even less inpatient monitoring 4
• No guideline evidence supports routine inpatient admission for uncomplicated cervical laminoplasty in neurologically stable patients 1

Clinical Factors Supporting Outpatient Surgery

This patient has favorable characteristics for outpatient management:

• Young age (31 years) - younger patients have better prognosis and recovery 2
• Ambulatory and neurologically stable - no acute cord compression requiring emergency intervention 1
• No comorbidities mentioned that would necessitate inpatient monitoring (e.g., uncontrolled diabetes, which is a negative prognostic factor) 1
• Elective procedure with planned date allowing for proper outpatient surgical preparation 1

Expected Outcomes Support Outpatient Approach

Laminoplasty outcomes data demonstrate:

• 55-60% recovery rate on JOA scale with functional improvement maintained at 5-10 year follow-up 1
• Good-to-excellent results in 93-97% of appropriately selected patients 1, 5
• Most common postoperative complaint is neck pain (22%), which is manageable in outpatient setting 1
• Serious complications requiring prolonged hospitalization are rare in properly selected patients 1

Common Pitfalls to Avoid

• Do not confuse the complexity of multilevel surgery with need for inpatient stay - the number of levels decompressed does not automatically mandate admission 1
• Avoid unnecessary hospitalization costs when clinical factors support safe outpatient management 1
• Ensure adequate pain control protocols are in place for outpatient discharge, as neck pain is the most common postoperative complaint 1

GUIDELINE REFERENCES

• Journal of Neurosurgery guidelines (2009) on cervical laminoforaminotomy demonstrate outpatient feasibility with zero readmissions in 183-patient prospective series 1
• Journal of Neurosurgery guidelines (2009) on cervical laminoplasty recommend the procedure for multilevel CSM but provide no evidence supporting routine inpatient admission 1
• Praxis Medical Insights synthesis confirms surgical intervention is warranted when conservative treatment fails, with posterior approaches appropriate for this pathology 2, 5, 3

APPROVED INPATIENT DAYS: ZERO (0)

Recommend outpatient/ambulatory surgery center setting with same-day discharge and appropriate outpatient follow-up within 7-14 days postoperatively.