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CPT® Code 63287

Official Description

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar

Common Language Description

The procedure described by CPT® Code 63287 involves a laminectomy performed specifically for the biopsy or excision of an intraspinal neoplasm located intradurally and intramedullarily within the thoracolumbar region of the spine. An intraspinal neoplasm refers to a tumor that can be benign, malignant, or of uncertain behavior, situated within the protective dura mater that surrounds the spinal cord. In this surgical intervention, the tumor is accessed through an incision made in the skin over the affected cervical, thoracic, or lumbar area, depending on the tumor's location. The procedure entails careful dissection to expose the spinal cord and the tumor, which is identified within the dura mater. The surgical approach allows for either obtaining a tissue sample for pathology or excising the tumor entirely, depending on its characteristics and extent. The use of an operating microscope aids in the meticulous dissection of the tumor from surrounding tissues, ensuring that it is completely removed if possible. The procedure concludes with the closure of the dura mater, which may involve sutures or a dural patch graft to restore the integrity of the spinal canal.

Procedure Details

1. Indications

The procedure is indicated for the evaluation and treatment of intraspinal neoplasms that are located intradurally and intramedullarily within the thoracolumbar region. The following conditions may warrant this surgical intervention:

Intraspinal Neoplasm A tumor that may be benign, malignant, or of uncertain behavior, requiring biopsy or excision for diagnosis or treatment.
Neurological Symptoms Symptoms such as pain, weakness, or sensory changes that may be associated with the presence of a spinal tumor.
Diagnostic Necessity The need for histological examination of the tumor to determine its nature and appropriate management.

2. Procedure

The procedure consists of several critical steps to ensure proper access and management of the intraspinal neoplasm:

Step 1: Incision The surgeon begins by making an incision in the skin over the cervical, thoracic, or lumbar region, depending on the tumor's location. This incision is carefully 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 muscle tissue is retracted away from the lamina and facet joint to expose the bony structures of the spine.
Step 3: Laminectomy A bone drill is utilized to remove part or all of the lamina, which is the bony arch of the vertebra, allowing for direct visualization of the spinal cord and the tumor located within the dura mater.
Step 4: Tumor Identification The tumor is identified within the dura mater, and the dura is incised over the site of the tumor to gain access to the neoplasm.
Step 5: Biopsy or Excision If the tumor is determined to extend into the spinal cord tissues, a tissue sample may be obtained for pathology. Following the biopsy, the physician may proceed to excise the tumor if feasible. The tumor is carefully dissected away from surrounding tissues using an operating microscope to ensure precision.
Step 6: Closure After the tumor is completely excised, the dura is closed using sutures or a dural patch graft to restore the protective covering of the spinal cord.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the surgery, such as infection or cerebrospinal fluid leaks. Patients may experience pain at the surgical site, which can be managed with appropriate analgesics. Rehabilitation may be necessary to address any neurological deficits or to aid in recovery. Follow-up appointments are essential to assess the surgical site and to review pathology results if a biopsy was performed. The overall recovery time may vary based on the extent of the procedure and the patient's overall health status.

Code Data Insights

Short Descr	BX/EXC IDRL IMED LESN THRLMB
Medium Descr	LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR
Long Descr	Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, 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	9 - Other OR therapeutic nervous system procedures

Add-On Codes

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)

Modifier Assist

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).
58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
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.
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.)
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
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

Chapter & Section Hierarchy

Personal Notes

Code History

Date	Action	Notes
2013-01-01	Changed	Short Descriptor changed.
Pre-1990	Added	Code added.

ICD-10-PCS Crosswalk

Code	Description

005T0ZZ	Destruction of Spinal Meninges, Open Approach
005T3ZZ	Destruction of Spinal Meninges, Percutaneous Approach
005T4ZZ	Destruction of Spinal Meninges, Percutaneous Endoscopic Approach
005W0ZZ	Destruction of Cervical Spinal Cord, Open Approach
005W3ZZ	Destruction of Cervical Spinal Cord, Percutaneous Approach
005W4ZZ	Destruction of Cervical Spinal Cord, Percutaneous Endoscopic Approach
005X0ZZ	Destruction of Thoracic Spinal Cord, Open Approach
005X3ZZ	Destruction of Thoracic Spinal Cord, Percutaneous Approach
005X4ZZ	Destruction of Thoracic Spinal Cord, Percutaneous Endoscopic Approach
005Y0ZZ	Destruction of Lumbar Spinal Cord, Open Approach
005Y3ZZ	Destruction of Lumbar Spinal Cord, Percutaneous Approach
005Y4ZZ	Destruction of Lumbar Spinal Cord, Percutaneous Endoscopic Approach
009T0ZX	Drainage of Spinal Meninges, Open Approach, Diagnostic
009T3ZX	Drainage of Spinal Meninges, Percutaneous Approach, Diagnostic
009T4ZX	Drainage of Spinal Meninges, Percutaneous Endoscopic Approach, Diagnostic
009U0ZX	Drainage of Spinal Canal, Open Approach, Diagnostic
009U3ZX	Drainage of Spinal Canal, Percutaneous Approach, Diagnostic
009U4ZX	Drainage of Spinal Canal, Percutaneous Endoscopic Approach, Diagnostic
009W0ZX	Drainage of Cervical Spinal Cord, Open Approach, Diagnostic
009W3ZX	Drainage of Cervical Spinal Cord, Percutaneous Approach, Diagnostic
009W4ZX	Drainage of Cervical Spinal Cord, Percutaneous Endoscopic Approach, Diagnostic
009X0ZX	Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic
009X3ZX	Drainage of Thoracic Spinal Cord, Percutaneous Approach, Diagnostic
009X4ZX	Drainage of Thoracic Spinal Cord, Percutaneous Endoscopic Approach, Diagnostic
009Y0ZX	Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic
009Y3ZX	Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagnostic
009Y4ZX	Drainage of Lumbar Spinal Cord, Percutaneous Endoscopic Approach, Diagnostic
00B20ZX	Excision of Dura Mater, Open Approach, Diagnostic
00B20ZZ	Excision of Dura Mater, Open Approach
00B23ZX	Excision of Dura Mater, Percutaneous Approach, Diagnostic
00B23ZZ	Excision of Dura Mater, Percutaneous Approach
00BT0ZX	Excision of Spinal Meninges, Open Approach, Diagnostic
00BT0ZZ	Excision of Spinal Meninges, Open Approach
00BT3ZX	Excision of Spinal Meninges, Percutaneous Approach, Diagnostic
00BT3ZZ	Excision of Spinal Meninges, Percutaneous Approach
00BT4ZX	Excision of Spinal Meninges, Percutaneous Endoscopic Approach, Diagnostic
00BT4ZZ	Excision of Spinal Meninges, Percutaneous Endoscopic Approach
00BW0ZX	Excision of Cervical Spinal Cord, Open Approach, Diagnostic
00BW0ZZ	Excision of Cervical Spinal Cord, Open Approach
00BW3ZX	Excision of Cervical Spinal Cord, Percutaneous Approach, Diagnostic
00BW3ZZ	Excision of Cervical Spinal Cord, Percutaneous Approach
00BW4ZX	Excision of Cervical Spinal Cord, Percutaneous Endoscopic Approach, Diagnostic
00BW4ZZ	Excision of Cervical Spinal Cord, Percutaneous Endoscopic Approach
00BX0ZX	Excision of Thoracic Spinal Cord, Open Approach, Diagnostic
00BX0ZZ	Excision of Thoracic Spinal Cord, Open Approach
00BX3ZX	Excision of Thoracic Spinal Cord, Percutaneous Approach, Diagnostic
00BX3ZZ	Excision of Thoracic Spinal Cord, Percutaneous Approach
00BX4ZX	Excision of Thoracic Spinal Cord, Percutaneous Endoscopic Approach, Diagnostic
00BX4ZZ	Excision of Thoracic Spinal Cord, Percutaneous Endoscopic Approach
00BY0ZX	Excision of Lumbar Spinal Cord, Open Approach, Diagnostic
00BY0ZZ	Excision of Lumbar Spinal Cord, Open Approach
00BY3ZX	Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagnostic
00BY3ZZ	Excision of Lumbar Spinal Cord, Percutaneous Approach
00BY4ZX	Excision of Lumbar Spinal Cord, Percutaneous Endoscopic Approach, Diagnostic
00BY4ZZ	Excision of Lumbar Spinal Cord, Percutaneous Endoscopic Approach
No matching codes found

NCCI Crosswalk

Code	Description

58	Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: For treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
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.
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.)
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
No matching codes found

HCPCS Crosswalk

Code	Description

E0650	Pneumatic compressor, non-segmental home model
E0651	Pneumatic compressor, segmental home model without calibrated gradient pressure
E0652	Pneumatic compressor, segmental home model with calibrated gradient pressure
E0655	Non-segmental pneumatic appliance for use with pneumatic compressor, half arm
E0656	Segmental pneumatic appliance for use with pneumatic compressor, trunk
E0657	Segmental pneumatic appliance for use with pneumatic compressor, chest
E0660	Non-segmental pneumatic appliance for use with pneumatic compressor, full leg
E0665	Non-segmental pneumatic appliance for use with pneumatic compressor, full arm
E0666	Non-segmental pneumatic appliance for use with pneumatic compressor, half leg
E0667	Segmental pneumatic appliance for use with pneumatic compressor, full leg
E0668	Segmental pneumatic appliance for use with pneumatic compressor, full arm
E0669	Segmental pneumatic appliance for use with pneumatic compressor, half leg
E0670	Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk
E0671	Segmental gradient pressure pneumatic appliance, full leg
E0672	Segmental gradient pressure pneumatic appliance, full arm
E0673	Segmental gradient pressure pneumatic appliance, half leg
E0675	Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)
J1094	Injection, dexamethasone acetate, 1 mg
J1100	Injection, dexamethasone sodium phosphate, 1 mg
J1645	Injection, dalteparin sodium, per 2500 iu
J1650	Injection, enoxaparin sodium, 10 mg
J1652	Injection, fondaparinux sodium, 0.5 mg
J1655	Injection, tinzaparin sodium, 1000 iu
J7637	Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
J7638	Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
J8540	Dexamethasone, oral, 0.25 mg
J9000	Injection, doxorubicin hydrochloride, 10 mg
Q2050	Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg
No matching codes found

ICD-9 Crosswalk

Code	Description

170.2	Malignant neoplasm of vertebral column, excluding sacrum and coccyx
192.1	Malignant neoplasm of cerebral meninges
192.2	Malignant neoplasm of spinal cord
192.3	Malignant neoplasm of spinal meninges
198.3	Secondary malignant neoplasm of brain and spinal cord
213.2	Benign neoplasm of vertebral column, excluding sacrum and coccyx
225.3	Benign neoplasm of spinal cord
225.4	Benign neoplasm of spinal meninges
237.5	Neoplasm of uncertain behavior of brain and spinal cord
No matching codes found