CPT® Code 63704

1. Indications

The procedure associated with CPT® Code 63704 is indicated for the surgical repair of myelomeningocele, particularly when the defect is less than 5 cm in diameter. This condition is typically diagnosed in utero or shortly after birth, and the indications for surgery include:

• Presence of Myelomeningocele: The surgical intervention is necessary to address the protrusion of the spinal cord and meninges through the spinal defect.
• Neurological Impairments: The procedure is indicated to prevent or mitigate potential neurological damage and associated complications that may arise from the exposure of neural tissues.
• Prevention of Infection: Repairing the defect helps to reduce the risk of infection that can occur when the spinal cord and meninges are exposed to the external environment.
• Management of Cerebrospinal Fluid: The procedure may also be indicated to manage excess cerebrospinal fluid that can accumulate in the sac, which can lead to further complications.

2. Procedure

The surgical procedure for the repair of myelomeningocele as described by CPT® Code 63704 involves several critical steps:

• Step 1: Incision of the Membrane: The surgeon begins by making an incision in the thin membrane, or sac, that covers the protruding spinal cord and meninges. This step is essential to access the underlying structures and to prepare for further intervention.
• Step 2: Drainage of Excess Fluid: Once the membrane is incised, any excess cerebrospinal fluid that has accumulated within the sac is carefully drained. This step is crucial to relieve pressure and prevent complications associated with fluid buildup.
• Step 3: Closure of the Dura Mater: After the fluid has been drained, the dura mater, which is the tough outer layer of the meninges, is sutured closed over the spinal cord. This closure is vital for protecting the neural structures from external trauma and infection.
• Step 4: Layered Closure of the Skin: Following the closure of the dura mater, the skin is closed in layers over the repaired area. This layered approach ensures that the skin adequately covers the protruding meninges, spinal cord, and nerves, promoting proper healing.
• Step 5: Creation of a Skin Flap (if necessary): In cases where direct closure of the defect is not possible due to the size or condition of the surrounding tissue, a skin flap may be created. This involves taking a section of skin from the back or buttocks, rotating it to cover the defect, and suturing it to the surrounding tissue to ensure adequate coverage and healing.

3. Post-Procedure

Post-procedure care following the repair of myelomeningocele is critical for ensuring optimal recovery and minimizing complications. Patients are typically monitored for signs of infection, cerebrospinal fluid leakage, and neurological function. Pain management is also an essential aspect of post-operative care. Patients may require a period of immobilization to allow for proper healing of the surgical site. Follow-up appointments are necessary to assess the surgical site, monitor recovery, and evaluate any potential neurological outcomes. Additionally, families may receive education on care practices and signs of complications to watch for during the recovery period.