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Official Description

Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 63290 involves a laminectomy performed specifically for the biopsy or excision of an intraspinal neoplasm that presents as a combined extradural-intradural lesion. An intraspinal neoplasm refers to a tumor located within the spinal canal, which can be classified as benign, malignant, or of uncertain behavior. In this context, the tumor is situated outside the dura mater, the protective membrane surrounding the spinal cord, but extends into the dura itself. The laminectomy procedure entails making an incision in the skin over the affected area of the spine, which may be in the cervical, thoracic, lumbar, or sacral regions, depending on the tumor's location. The surgical approach requires careful dissection to expose the lamina, the bony structure of the vertebrae, and the spinal cord. The surgeon utilizes a bone drill to remove part or all of the lamina to gain access to the tumor. Once the tumor is located, it is evaluated to confirm its extent and relationship to the dura mater. A biopsy may be performed to obtain a tissue sample for pathological examination. If the tumor is deemed excisable, the surgeon meticulously dissects it from surrounding tissues, often using an operating microscope for precision. After complete removal, the dura is closed with sutures or a dural patch graft to ensure proper healing and protection of the spinal cord. This procedure is critical for diagnosing and treating spinal tumors, allowing for both evaluation and potential removal of neoplastic tissue.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 63290 is indicated for the evaluation and treatment of intraspinal neoplasms that are characterized as combined extradural-intradural lesions. These tumors may present with various symptoms, including but not limited to:

  • Neurological deficits Symptoms such as weakness, numbness, or loss of function in the limbs may occur due to compression of the spinal cord or nerve roots.
  • Pain Patients may experience localized or radiating pain in the back or extremities, which can be a result of tumor growth or associated inflammation.
  • Changes in bowel or bladder function Disruption of normal function may indicate involvement of the spinal cord or nerve roots by the neoplasm.
  • Progressive symptoms Any worsening of neurological symptoms or pain that does not respond to conservative treatment may warrant surgical intervention.

2. Procedure

The laminectomy procedure for biopsy or excision of an intraspinal neoplasm involves several critical steps, which are detailed as follows:

  • Step 1: Incision The surgeon begins by making an incision in the skin over the cervical, thoracic, lumbar, or sacral region, depending on the tumor's location. This incision is carefully planned to provide optimal access to the affected area.
  • Step 2: Exposure The incision is extended down to the spinous processes, and the surrounding muscle is retracted away from the lamina and facet joint to expose the underlying 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. This step is crucial for gaining access to the spinal canal and exposing the spinal cord.
  • Step 4: Tumor Evaluation Once the spinal cord is exposed, the surgeon locates the tumor outside the dura mater. The tumor is evaluated to determine its extent and whether it has invaded the dura.
  • Step 5: Dural Incision If the tumor extends into the dura mater, the surgeon incises the dura over the site of the lesion to access the tumor directly.
  • Step 6: Biopsy and Excision A tissue sample may be obtained for pathology examination. Following the biopsy, if the tumor is deemed excisable, the surgeon carefully dissects it away from surrounding tissues, often using an operating microscope for enhanced visualization and precision.
  • Step 7: Closure After the tumor is completely excised, the dura is closed with sutures or a dural patch graft to restore the integrity of the protective covering of the spinal cord.

3. Post-Procedure

Post-procedure care following a laminectomy for biopsy or excision of an intraspinal neoplasm includes monitoring for any complications such as infection, cerebrospinal fluid leaks, or neurological deficits. Patients may require pain management and physical therapy to aid in recovery. The expected recovery period can vary based on the extent of the surgery and the patient's overall health. Follow-up appointments are essential to assess healing and to discuss pathology results from the biopsy, which will guide further treatment decisions if necessary.

Short Descr BX/EXC XDRL/IDRL LSN ANY LVL
Medium Descr LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL
Long Descr Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level
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

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).
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.
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 Short Descriptor changed.
Pre-1990 Added Code added.
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