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An intramedullary cyst or syrinx is a rare type of lesion characterized by a fluid-filled cavity located within the spinal cord. This condition can lead to various neurological symptoms depending on its size and location. The procedure described by CPT® Code 63172 involves a laminectomy, which is a surgical operation that entails the removal of a portion of the lamina, the bony arch of the vertebra that covers the spinal canal. The surgery is performed through an incision in the skin over the cervical, thoracic, or thoracolumbar region, where the cyst or syrinx is situated. The incision is extended down to the spinous processes, allowing access to the underlying structures. During the procedure, muscles are retracted away from the lamina and facet joint to provide a clear view of the spinal canal. A bone drill is then utilized to remove part or all of the lamina, which exposes the spinal cord. Once the spinal cord is visible, the cyst or syrinx is evaluated, and the lesion is incised and drained. A drain is subsequently placed within the lesion to facilitate the removal of fluid. Notably, in this specific procedure, the drain is tunneled and secured to terminate in the subarachnoid space, which is the area between the arachnoid membrane and the pia mater that envelops the spinal cord. This approach is crucial for managing the fluid accumulation associated with the cyst or syrinx effectively.
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The procedure described by CPT® Code 63172 is indicated for the treatment of intramedullary cysts or syrinxes that may be causing neurological symptoms or complications. These lesions can lead to various issues, including pain, weakness, sensory deficits, or other neurological impairments, depending on their size and location within the spinal cord. The surgical intervention aims to alleviate these symptoms by removing the cyst or syrinx and facilitating the drainage of fluid accumulation.
The procedure for CPT® Code 63172 involves several critical steps to ensure effective treatment of the intramedullary cyst or syrinx. First, the surgeon makes an incision in the skin over the cervical, thoracic, or thoracolumbar region, depending on the location of the lesion. This incision is extended down to the spinous processes to provide adequate access to the underlying structures. Next, the muscles are carefully retracted away from the lamina and facet joint to expose the bony architecture of the spine. A bone drill is then employed to remove part or all of the lamina, which is essential for exposing the spinal cord. Once the spinal cord is visible, the surgeon evaluates the cyst or syrinx to determine the best approach for drainage. The lesion is then incised, allowing for the drainage of the fluid contained within. Following this, a drain is placed into the lesion to facilitate ongoing fluid removal. Importantly, in this procedure, the drain is tunneled and secured to terminate in the subarachnoid space, which is the area between the arachnoid membrane and the pia mater that covers the spinal cord. This specific placement of the drain is crucial for managing the fluid accumulation effectively and ensuring optimal recovery.
After the completion of the procedure, post-operative care is essential for ensuring proper recovery. Patients are typically monitored for any signs of complications, such as infection or cerebrospinal fluid leaks. The placement of the drain in the subarachnoid space requires careful management to prevent any adverse effects. Patients may experience some discomfort or pain at the surgical site, which can be managed with appropriate analgesics. Follow-up appointments are necessary to assess the effectiveness of the drainage and to monitor the patient's neurological status. The surgical incisions will be closed, and instructions regarding activity restrictions and wound care will be provided to promote healing and prevent complications.
| Short Descr | DRAINAGE OF SPINAL CYST | Medium Descr | LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID | Long Descr | Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1F - Major procedure - explor/decompr/excis disc | MUE | 1 | CCS Clinical Classification | 3 - Laminectomy, excision intervertebral disc |
This is a primary code that can be used with these additional add-on codes.
| 22840 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) | 22841 | Addon Code MPFS Status: Bundled Code APC C Physician Quality Reporting CPT Assistant Article Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) | 22842 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) | 22843 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) | 22844 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure) | 22845 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) | 22846 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) | 22847 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) | 22848 | Addon Code MPFS Status: Active Code APC N Physician Quality Reporting CPT Assistant Article Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) | 22853 | CPT Add On MPFS Status: Active Code APC N ASC N1 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) | 22854 | CPT Add On MPFS Status: Active Code APC N ASC N1 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) | 22859 | CPT Add On CPT Resequenced MPFS Status: Active Code APC N ASC N1 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) | 63295 | Addon Code MPFS Status: Active Code APC C Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (List separately in addition to code for primary procedure) | 69990 | Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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