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Official Description

Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal or pleural space

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

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 63173 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 to provide adequate access to the affected area. During the procedure, muscles are retracted to expose the lamina and facet joint, allowing the surgeon to utilize a bone drill to remove part or all of the lamina. This exposure enables the surgeon to evaluate the spinal cord and the cyst or syrinx directly. The lesion is then incised and drained, with a drain being placed into the cyst or syrinx to facilitate the removal of fluid. In this specific procedure, the drain is tunneled to exit into the peritoneal or pleural cavity, which is a significant distinction from similar procedures where the drain may terminate in the subarachnoid space. The peritoneum or pleura is incised to allow for the placement of the drain, which is then secured before the surgical incisions are closed. This procedure aims to alleviate symptoms associated with the cyst or syrinx and prevent further complications related to the condition.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 63173 is indicated for the treatment of intramedullary cysts or syrinxes that may be causing neurological symptoms or complications. The following conditions may warrant this surgical intervention:

  • Intramedullary Cyst A fluid-filled cavity within the spinal cord that may lead to compression of neural structures, resulting in pain, weakness, or sensory deficits.
  • Syrinx A cystic formation within the spinal cord that can expand and cause damage to surrounding tissues, potentially leading to neurological dysfunction.
  • Neurological Symptoms Symptoms such as pain, weakness, or sensory changes that are attributable to the presence of an intramedullary cyst or syrinx.

2. Procedure

The procedure for CPT® Code 63173 involves several critical steps to ensure effective treatment of the intramedullary cyst or syrinx:

  • Step 1: Incision The surgical process begins with an incision made over the cervical, thoracic, or thoracolumbar region, depending on the location of the cyst or syrinx. This incision is extended down to the spinous processes to provide adequate access to the underlying structures.
  • Step 2: Muscle Retraction Once the incision is made, the surrounding muscles are carefully retracted away from the lamina and facet joint. This retraction is essential to expose the bony structures and the spinal canal for the subsequent steps of the procedure.
  • Step 3: Laminectomy A bone drill is utilized to remove part or all of the lamina, which is the bony arch of the vertebra. This step is crucial for exposing the spinal cord and the cyst or syrinx that needs to be addressed.
  • Step 4: Evaluation of the Cyst/Syrinx With the spinal cord exposed, the surgeon evaluates the cyst or syrinx to determine its characteristics and the best approach for drainage.
  • Step 5: Incision and Drainage The lesion is incised, and the fluid within the cyst or syrinx is drained. This step is vital for alleviating pressure on the spinal cord and reducing associated symptoms.
  • Step 6: Drain Placement A drain is placed into the lesion to facilitate ongoing drainage of fluid. In this procedure, the drain is tunneled to exit into the peritoneal or pleural cavity, which is a key aspect of the surgical approach.
  • Step 7: Incision Closure After securing the drain, the peritoneum or pleura is incised to allow for the drain placement, and the surgical incisions are then closed to complete the procedure.

3. Post-Procedure

Post-procedure care following a laminectomy with drainage of an intramedullary cyst or syrinx involves monitoring for any complications related to the surgery. Patients may require pain management and should be observed for signs of infection or fluid accumulation. The drain placed in the peritoneal or pleural cavity will need to be monitored for proper function and output. Follow-up appointments are essential to assess the patient's recovery and to ensure that the cyst or syrinx has been adequately addressed. Rehabilitation may be necessary to help restore function and mobility, depending on the extent of neurological involvement prior to the procedure.

Short Descr DRAINAGE OF SPINAL CYST
Medium Descr LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL
Long Descr Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal or pleural 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)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
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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2004-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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