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Official Description

Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Laminectomy for excision or occlusion of arteriovenous malformation (AVM) of the spinal cord, specifically coded as CPT® 63252, is a surgical procedure aimed at addressing a rare congenital anomaly characterized by an abnormal tangle of arteries and veins located on, in, or near the spinal cord. This condition can lead to significant complications, including the potential for oxygen deprivation to the spinal cord tissues, which may result in tissue necrosis. Additionally, the presence of an AVM can cause the rupture of fragile blood vessels or exert pressure on the spinal cord, leading to neurological deficits. During the procedure, an incision is made over the thoracolumbar region where the AVM is situated, extending down to the spinous processes. The muscles are carefully retracted to expose the lamina and facet joint. A specialized bone drill is utilized to remove part or all of the lamina, allowing for direct access to the spinal cord. Once the spinal cord is exposed, the AVM is identified, and the blood vessels supplying it are located and ligated with sutures. The AVM can then be excised or permanently occluded using sutures or clamps, effectively addressing the vascular anomaly and mitigating the associated risks.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure coded as CPT® 63252 is indicated for the treatment of arteriovenous malformations (AVMs) located in the thoracolumbar region of the spinal cord. The following conditions may warrant this surgical intervention:

  • Spinal Cord AVM A congenital anomaly characterized by an abnormal tangle of arteries and veins that can disrupt normal blood flow to the spinal cord.
  • Oxygen Deprivation The presence of an AVM may prevent adequate oxygenated blood from reaching spinal cord tissues, leading to potential tissue death.
  • Rupture Risk AVMs can lead to the rupture of weakened blood vessels, posing a risk of hemorrhage and neurological complications.
  • Compression Symptoms The AVM may exert pressure on the spinal cord, resulting in neurological deficits or other complications that necessitate surgical intervention.

2. Procedure

The laminectomy procedure for excision or occlusion of a spinal cord AVM involves several critical steps:

  • Incision A surgical incision is made over the thoracolumbar region where the AVM is located, extending down to the spinous processes to provide adequate access to the underlying structures.
  • Muscle Retraction The muscles surrounding the lamina and facet joint are carefully retracted to expose the bony structures of the spine, ensuring a clear view of the surgical field.
  • Lamina Removal A bone drill is employed to remove part or all of the lamina, which is the bony arch of the vertebra, allowing for direct access to the spinal cord and the AVM.
  • AVM Identification Once the spinal cord is exposed, the surgeon locates the AVM, identifying the abnormal blood vessels that comprise the malformation.
  • Vessel Ligation The blood vessels supplying the AVM are carefully identified and ligated with sutures to prevent blood flow to the malformation.
  • AVM Excision or Occlusion The AVM is either excised or permanently occluded using sutures or clamps, effectively removing or blocking the abnormal vascular structure and mitigating the associated risks.

3. Post-Procedure

After the completion of the laminectomy for AVM excision or occlusion, patients typically require careful monitoring for any signs of complications, such as bleeding or infection. Post-operative care may include pain management, physical therapy, and follow-up imaging studies to assess the success of the procedure and ensure that the AVM has been adequately addressed. Recovery time can vary based on the extent of the surgery and the patient's overall health, but patients are generally advised to avoid strenuous activities during the initial healing phase to promote optimal recovery.

Short Descr REVISE SPINE CORD VSL THRLMB
Medium Descr LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR
Long Descr Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar
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) P1G - Major procedure - Other
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.
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).
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
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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2013-01-01 Changed Description Changed
Pre-1990 Added Code added.
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