2025 CPT code 63170
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Laminectomy with myelotomy (e.g., Bischof or DREZ type), cervical, thoracic, or thoracolumbar.
Modifiers may apply depending on the specific circumstances of the procedure. Consult the most current CPT guidelines and payer-specific requirements.
Medical necessity for a laminectomy with myelotomy is established when chronic severe neuropathic pain persists despite adequate conservative management.The procedure is considered only when other less invasive options have failed. The documentation should support the diagnosis and the rationale for surgery.
A neurosurgeon or spine surgeon performs the laminectomy with myelotomy. The procedure requires expertise in surgical anatomy of the spine and spinal cord, as well as knowledge of various lesioning techniques.
In simple words: This surgery removes a piece of bone from the spine (laminectomy) to relieve pressure on the spinal cord or nerves.It also involves destroying a small part of the spinal cord (myelotomy) to treat severe, ongoing nerve pain that hasn't responded to other treatments.
Laminectomy with myelotomy, also known as DREZ lesioning, is a surgical procedure involving the excision of the lamina (a thin plate of bone at the back of a vertebra) to decompress the spinal cord or nerve roots.The procedure extends to the destruction of the posterolateral portion of the spinal cord to treat chronic, severe neuropathic pain unresponsive to other therapies.This may involve techniques such as cutting nerve roots with a surgical blade and coagulation, radiofrequency ablation, laser ablation (CO2 or argon), or focused ultrasound.
Example 1: A 55-year-old male patient presents with chronic, intractable neuropathic pain in his lower extremities following a motor vehicle accident.Conservative management (physical therapy, medication) has failed to provide relief.A laminectomy with myelotomy (DREZ lesioning) is performed to alleviate his pain., A 40-year-old female patient suffers from chronic back pain and radiculopathy secondary to a herniated disc.After unsuccessful conservative management, a laminectomy with myelotomy is undertaken as a last resort before spinal fusion., A 60-year-old patient with multiple sclerosis experiences debilitating neuropathic pain. Other therapies have been unsuccessful.A laminectomy with myelotomy is performed to target the specific nerve roots causing the pain.
* Detailed history and physical examination documenting the nature and severity of the neuropathic pain.* Results of previous conservative treatments, including medications and therapies attempted.* Imaging studies (MRI, CT) demonstrating the anatomical basis for the pain (e.g., spinal stenosis, nerve root compression).* Intraoperative findings, including the location and extent of the myelotomy.* Postoperative course, including pain relief and any complications.
** This procedure is considered a high-risk intervention with potential complications such as infection, bleeding, nerve damage, and paralysis.Careful patient selection and informed consent are critical.
- Revenue Code: P1F (MAJOR PROCEDURE - EXPLOR/DECOMPR/EXCISDISC)
- RVU: Information not available in provided source.Consult the most current Relative Value Units (RVUs) from CMS.
- Global Days: Information not available in provided source.The global period will vary depending on payer and other factors.
- Payment Status: Active
- Modifier TC rule: The application of TC modifier is not applicable to this code.
- Fee Schedule: Historical fee schedule data is not available in the provided source. Consult the appropriate fee schedules from the payer.
- Specialties:Neurosurgery, Orthopedic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center