Neurosurgery Coding Alert

Question: Patient has multiple Tarlov's Cysts (CSF filled sacs located on the spinal roots) between S1-S4. Surgeon removed the entire S1-S4 lamina in full. He then dissected the cysts from the surrounding tissues and nerve roots. The space was packed with BMP and then the lamina is replaced using miniplates and screws.

North Carolina Subscriber

Answer: Since Tarlov cysts are considered extradural, non-neoplastic lesions, you would report 63268 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral) for the dissection of the Tarlov's cyst. Placement of BMP sponges can be reported with 20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only [List separately in addition to code for primary procedure]). The closure of the lamina with plate fixation is considered a bundled service.