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Laminectomy with cordotomy, as described by CPT® Code 63197, involves a surgical procedure aimed at selectively destroying the anterior spinothalamic tract, which is the primary pathway for pain transmission within the spinal cord. This tract is situated bilaterally in the anterolateral aspect of the spinal cord, with each side transmitting sensory information from the opposite side of the body to the brain. The procedure is typically indicated for patients experiencing severe unilateral pain, often due to malignancy, particularly in terminally ill individuals. Although advancements in pain management techniques have reduced the frequency of cordotomy procedures, it remains a viable option in specific cases where pain relief is critical. The surgical approach begins with an incision over the thoracic vertebrae, extending down to the spinous processes, allowing access to the spinal structures. Through careful dissection and retraction of the surrounding muscles, the lamina is removed using a bone drill, ultimately exposing the spinal cord. The targeted spinothalamic tracts are then identified and sectioned on both sides of the thoracic spinal cord, effectively interrupting the pain transmission pathway.
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The procedure of laminectomy with cordotomy is indicated for specific conditions where pain management is critical, particularly in terminally ill patients. The following indications are explicitly recognized for this procedure:
The laminectomy with cordotomy procedure involves several critical steps to ensure effective access to the spinal cord and the targeted spinothalamic tracts. The following procedural steps are outlined:
Post-procedure care following a laminectomy with cordotomy is essential for patient recovery and monitoring. Patients may experience immediate relief from pain, but they should be closely observed for any potential complications, such as infection or neurological deficits. Pain management protocols will be adjusted based on the patient's response to the procedure. Rehabilitation may be necessary to aid in recovery, and follow-up appointments will be scheduled to assess the effectiveness of the procedure and the patient's overall condition. It is important for healthcare providers to educate patients about potential changes in sensation and to provide support for any emotional or psychological impacts resulting from the procedure.
| Short Descr | LAM W/CORDOTOMY 1STG THRC | Medium Descr | LAM W/CORDOTOMY SCTJ SPINOTHALAMIC TRC 1STG THRC | Long Descr | Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage, thoracic | 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) | 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) |
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| 2022-01-01 | Changed | Medium and Short descriptions changed |
| 2022-01-01 | Note | Long description grammar change |
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2009-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |