Neurosurgery Coding Alert

Question: Can you help me with the following procedure? "T12, 11, 12 dissection to spinous process. Opened cyst wall l1; nerve roots coming thru cyst wall. Cerebrospinal fluid drainage. Placed lumbar drain above l1, brought out the drain and tunneled through skin."

Georgia Subscriber

Answer: It's not clear from your description whether the cyst is an intramedullary cyst or a cyst external to the spinal cord. The brief description suggests that the surgeon was treating an arachnoid cyst, which represents an intraspinal extradural thoracic non-neoplastic lesion. The drain placement is performed by some surgeons to reduce the risk of postoperative CSF leak. Assuming the surgeon treated an arachnoid cyst, code 63266 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic) would apply.