Coding assistance Hemi-Laminotomy C7 63001? and T-1 thru T-3 laminectomies with T-3 Intradural Excision


Dighton, MA
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Hello Everyone:

Was wondering if someone can shade some light on this op note. Not really sure of the codes.

1.C7 bilateral hemi-laminotomy, T1-T2 bilateral laminectomies and T3 bilateral hemi-laminotomy with excisional biopsy of intradural extramedullary spinal cord lesion.
2. Microsurgical techniques, requiring use of operating microscope.
3. Electrophysiological monitoring of somatosensory evoked potentials and motor evoked potentials.
4. Fluoroscopic guidance for localization.
5. intraoperative use of Ultrasound

This is 81 year old male who is diagnosed with T1 intradural tumor with the spinal cord compression. He also complains of left upper extremity pain. Initially the tumor was observed but the patient clinical symptoms worsen. Recently he had a deterioration of balance and gait. Left about extremity pain was very difficult to control. He was sent for epidural steroid injection. After multiple attempts, the injection did not happen. After detailed discussion with the patient and his health proxy [his sister], the decision made to proceed with the resection of the tumor.

The patient was prepped and draped in the standard sterile fashion. The C-arm fluoroscopy was draped and brought in to the operative field and the C7 spinous process localized. Local anesthetic was infiltrated along the line of the skin incision which was subsequently opened sharply with a # 10 scalpel blade. Further dissection was carried down in the midline until the level of supraspinous ligament utilizing bipolar forceps and Bovie electrocautery for hemostasis. The muscle was elevated subperiosteally from C7-T3. Hemostasis was achieved. Self-retaining retractors were then inserted. The posterior spinous processes of T1 and T2 were cut off with heavy bone cutters. Utilizing a high-speed pneumaticdrill, a full thickness groove was drilled through the bilateral T1 and T2 and bilateral hemi-laminotomies of C7 and T3 was performed. Sharp dissection was used to free ligamentum flavum from the superior border of T3 and the inferior border of T3 and the lamina uplifted carefully preserving the dura intact.
Again, hemostasis was meticulously achieved and the wound irrigated. The operating microscope was draped with sterile drapes brought into the operative field. Again, baseline SSEPs were obtained. Ultrasound was brought to the operative field, tumor was localized using intraoperative ultrasound.
The lateral recess of the dura and bone was lined with cottonoids. We then proceeded with opening the dura of the spinal cord. The arachnoid was carefully preserved. The dura was tacked up laterally, utilizing 4-0 (Nurolon) sutures. The arachnoid was then incised and mobilized laterally. The tumor was identified. Using microsurgical techniques, the tumor was dissected from the Dura using microscissors, Penfield #4 and bipolar electrocautery. The tumor was removed enbloc. The rest of the tumor was cauterized using bipolar electrocautery. SSEP and MEP were obtained, stable and at baseline.
The intradural space was irrigated until clear and hemostasis was meticulously achieved. Subsequently, the dura was closed in a water-tight fashion with 5-0
Gore-tex suture. Valsalva maneuver to 30 mmHg showed no leak. A very thin layer of dural sealant was applied. The posterior spinous processes were not replaced. Local tranexamic acid was applied to obtained hemostasis.
The fascia was subsequently closed utilizing 0 (Vicryl). Local anesthetic was given around the area and subcutaneous tissue was approximated with 2-0 Vicryl, after the wound had been copiously irrigated with antibiotic saline irrigation. Vancomycin powder was applied. The skin was then approximated with 3-0 nylon. Sterile dressing was applied.

Thank you in advance
Happy Thanksgiving


True Blue
Munising, MI
Best answers
You may want to look at the code range 63250-63290. It's a different set of codes from the 63001 area when it's for lesion/tumor and not herniated disc. You may be able to report the operating microscope with these too (I forget if it's inclusive or not with this code range). You would also want to check and see if the tumor was sent off for path.

Key words: excisional biopsy of intradural extramedullary spinal cord lesion
T1 intradural tumor with the spinal cord compression
the tumor was dissected from the Dura using microscissors