Summary & Overview
CPT 63191: Spinal Decompression with Partial Spinal Accessory Nerve Resection
Headline: CPT code 63191 defines a targeted spinal decompression procedure with partial resection of the spinal accessory nerve — a clinically specific operation for posterior cervical pain and lesion management.
Lead: CPT code 63191 represents an operative decompression that removes the lamina and part of the spinal accessory nerve to address painful spinal disorders such as herniated vertebral discs or lesions. The code identifies a specialized cervical/posterior neck surgical intervention with implications for surgical coding, payment, and clinical documentation nationwide.
Why it matters: This code identifies a relatively specialized spine operation that affects payer coverage, surgical setting selection, and documentation requirements. Clear coding of 63191 is important for consistent reimbursement, quality reporting, and clinical outcome tracking across hospitals and ambulatory surgery centers.
Payers covered: Analysis includes major commercial and public payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides clinical context for the procedure described by CPT code 63191, explains typical sites of service, summarizes common modifiers and billing considerations, and outlines where stakeholders can expect variability in coverage and payment. It also highlights documentation elements that support accurate reporting of an operative spinal decompression with partial accessory nerve resection.
This national overview is intended for coding professionals, surgical teams, billing departments, and policy analysts seeking concise guidance on the clinical and billing identity of CPT code 63191.
Billing Code Overview
CPT code 63191 describes a surgical procedure in which the provider removes the lamina (the arch of the vertebral bone) and resects part of the spinal accessory nerve in the posterior neck to treat spinal disorders that cause pain, such as a herniated vertebral disc or lesion. The description indicates an operative decompression and partial nerve resection focused on structures in the cervical/posterior neck region.
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Service type: Surgical spinal decompression with partial resection of the spinal accessory nerve
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Typical site of service: Hospital inpatient or hospital outpatient surgical setting; may also occur in ambulatory surgery centers for selected cases
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents with progressive axial neck pain, unilateral radicular pain into the upper extremity, motor weakness of the deltoid and biceps, and imaging demonstrating a symptomatic cervical laminar, foraminal or dorsal compressive lesion such as a hypertrophic ligament, focal epidural scar, or herniated/postoperative disc fragment compressing the posterior elements. After failure of conservative care (physical therapy, medications, epidural injections) and confirmed concordant findings on MRI and clinical exam, the spine surgeon schedules a posterior cervical decompression with partial removal of the lamina and resection of the involved dorsal accessory nerve root to relieve nerve compression and pain. The procedure is performed in an operating room under general anesthesia, with intraoperative neuromonitoring and sterile technique. Postoperative workflow includes PACU recovery, neurologic assessment, inpatient observation as indicated, pain control, wound care instructions, and a plan for physical therapy and outpatient follow-up for wound check and neurologic reassessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for the procedure (extensive scar tissue, unusually complex decompression). |