# Removal of a spine tumor



## skorkfranks (Oct 24, 2013)

I wanted to see if I have chosen the correct code. The Dx codes are 198.5 and 185. I am looking at CPT codes 63276 (for tumor removal at T8-T9), 63046-59 (T7), 63048+ (T10) 

The OP note states: 

Once the appropriate spinal levels were identified with intraoperative imaging, a rongeur was used to remove this spinous processes of T7, T8, T9, and T10. Once this was completed, the laminas were thinned bilaterally with the use of a rongeur and 
bur. A small curved curette was then used to undermine the insertion of ligamentum flavum on the undersurface of the lamina. All dural adhesions were freed from the surrounding bone and 
ligaments with the use of Penfield #3 and Woodson. A combination of #2-0 and #3-0 Kerrisons were used to perform a midline decompression and bilateral lateral recess decompression. There was a thorough decompression of the T7, T8, T9, and T10 lamina, 
followed by foraminotomies all involved nerve roots. Note that significant necrotic bone and tumor was encountered at the T8 and T9 levels. This was identified, gently teased away with pituitary and a Woodson was then placed between the plain of the dura 
and the tumor, and it was elevated away and removed piecewise. The left pedicle at T9 was virtually absent as well as significant tumor inferior to the T8 pedicle and in the process of performing the decompression in order to obtain adequate exposure to debulk 
the tumor, it was necessary to divide the left T8 nerve root. The nerve root was ligated with #4-0 nylon suture and then divided. Tumor that was removed was sent for pathology. The surface of the tumor was bipolar cauterized throughout the decompression. 

Thanks.


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