2025 CPT code 63286
Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Feed
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic
Modifiers may be applicable in certain situations (e.g., increased procedural services, multiple procedures).
Medical necessity must be established through documentation of the patient's symptoms, neurological deficits, and imaging findings confirming the presence of a thoracic intramedullary tumor requiring surgical intervention.
The surgeon performs the laminectomy, exposes the spinal cord, incises the dura, and excises the intradural, intramedullary tumor. They are responsible for preserving the surrounding neural structures and ensuring proper wound closure.
In simple words: The surgeon removes a piece of the backbone in your upper back to get to your spinal cord. They then carefully cut open the protective covering of the spinal cord and remove a tumor that's growing inside the cord itself. A small sample is taken for testing, and the surgeon tries to remove as much of the tumor as is safe.
This procedure involves removing a portion of the thoracic vertebra called the lamina to access and excise an intradural, intramedullary spinal cord tumor. A biopsy is taken, and the lesion is partially or completely removed. The dura, the protective membrane surrounding the spinal cord, is incised to allow access to the tumor within the spinal cord itself (intramedullary). The procedure typically utilizes magnification (loupe or operating microscope) for precision. The wound is then closed in layers.
Example 1: A patient presents with progressive weakness and sensory changes in the lower extremities. Imaging reveals an intramedullary tumor within the thoracic spinal cord. A laminectomy (63286) is performed to biopsy and debulk the tumor., A patient experiences pain and loss of function in the upper back. A thoracic intramedullary tumor is diagnosed. The patient undergoes a 63286 procedure to obtain a tissue sample for diagnosis and decompress the spinal cord by removing the tumor., An MRI reveals an intramedullary tumor at T6. The patient undergoes surgery (63286), where the surgeon removes part of the T6 vertebra and resects the tumor affecting the spinal cord.
Documentation should include operative reports detailing the surgical approach, tumor location, biopsy results, extent of resection, and any complications. Pre- and postoperative imaging studies, neurological assessments, and pathology reports are also crucial.
- Specialties:Neurosurgery, Orthopedic Surgery (Spine)
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center