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A meningocele is a specific type of spina bifida, which is a congenital defect resulting from improper closure of the neural tube during early fetal development, typically within the first month. In cases of meningocele, the spinal cord develops normally; however, the protective membranes surrounding the spinal cord, known as the meninges, protrude through an opening in the spine. This protrusion can create a sac-like structure that may be covered by a thin membrane. The procedure coded as CPT® 63702 involves the surgical repair of a meningocele that is larger than 5 cm in diameter. During the repair, a surgical incision is made in the membrane covering the meninges, allowing for the drainage of any excess cerebrospinal fluid that may be present. Following this, the skin is meticulously closed in layers over the protruding meninges to ensure proper healing and protection. In instances where direct closure of the defect is not feasible, a skin flap may be created from adjacent skin, such as that from the back or buttocks. This flap is then rotated to adequately cover the defect and is sutured to the surrounding tissue to secure it in place. It is important to note that CPT® 63700 is used for repairs of meningocele defects that are less than 5 cm in diameter, while CPT® 63702 is specifically designated for those that are 5 cm or larger.
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The procedure coded as CPT® 63702 is indicated for the surgical repair of a meningocele that is larger than 5 cm in diameter. This condition is typically identified during prenatal imaging or at birth, and it may present with various symptoms depending on the size and location of the defect. The primary indication for this surgical intervention is to prevent complications associated with the protrusion of the meninges, which can include infection, neurological impairment, and further damage to the spinal cord. The repair aims to restore the integrity of the spinal column and protect the underlying neural structures.
The surgical procedure for CPT® 63702 involves several critical steps to ensure effective repair of the meningocele. Initially, the surgeon makes an incision in the membrane, or sac, that covers the protruding meninges. This incision allows for the careful drainage of any excess cerebrospinal fluid that may be present, which is essential for reducing pressure and preventing infection. Once the fluid is drained, the next step involves assessing the defect and the surrounding tissue. If the defect is manageable, the surgeon will proceed to close the skin in layers over the protruding meninges, ensuring that the closure is secure and promotes optimal healing. However, if the defect is too large for direct closure, the surgeon will create a skin flap from adjacent skin, typically from the back or buttocks. This flap is then rotated to cover the defect adequately and is sutured to the surrounding tissue to ensure that it remains in place. This meticulous approach is crucial for minimizing the risk of complications and promoting a successful recovery.
After the surgical repair of a meningocele using CPT® 63702, post-procedure care is essential for ensuring proper healing and minimizing complications. Patients are typically monitored for signs of infection, cerebrospinal fluid leakage, and neurological function. Pain management is also an important aspect of post-operative care, and appropriate analgesics may be administered. The surgical site should be kept clean and dry, and any dressings should be changed as directed by the healthcare provider. Follow-up appointments are crucial to assess the healing process and to ensure that the defect is adequately closed. Patients may also require physical therapy or other supportive measures to aid in recovery, depending on the extent of the defect and any associated neurological concerns.
| Short Descr | REPAIR OF SPINAL HERNIATION | Medium Descr | REPAIR MENINGOCELE > 5 CM DIAMETER | Long Descr | Repair of meningocele; larger than 5 cm diameter | 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 |
| 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |
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