Summary & Overview
CPT 63250: Cervical Spinal Arteriovenous Malformation Obliteration
CPT code 63250 represents surgical treatment to obliterate an arteriovenous malformation (AVM) located within, on, or adjacent to the cervical spinal cord. This procedure isolates and eradicates the fistula and draining veins to address neurologic deficits (such as lower extremity weakness) and to prevent clinical progression. The code is used for reporting definitive neurosurgical or endovascular interventions on spinal AVMs in the cervical region. Nationally, accurate reporting of CPT code 63250 matters for clinical outcomes tracking, resource allocation for complex neurosurgical care, and accurate claims adjudication for high-acuity procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of CPT code 63250, typical sites of service, and the major payer landscape. The publication summarizes benchmarking and coverage considerations, highlights common billing modifiers associated with complex surgical services, and provides clinical context to support correct procedure identification and coding. The content is intended to inform coding specialists, revenue cycle staff, and policy analysts about the code’s clinical purpose, typical care settings, and areas to review in payer contracts and claims processing.
Billing Code Overview
CPT code 63250 describes a surgical procedure to remove or close abnormal direct connections between arteries and veins (an arteriovenous malformation, or AVM) located within, on, or near the cervical spinal cord. The goal of the procedure is to isolate and eradicate the fistula and its draining veins to resolve neurological dysfunction (for example, lower extremity weakness) and to prevent progression of the lesion.
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Service type: Surgical repair of spinal arteriovenous malformation (neurosurgical/endovascular occlusion or direct microsurgical obliteration)
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Typical site of service: Hospital inpatient or hospital outpatient surgical setting, conducted in an operating room or endovascular suite
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with progressive bilateral lower extremity weakness, gait instability, and sensory changes. Magnetic resonance imaging (MRI) of the cervical spine and confirmatory spinal angiography demonstrate a cervical spinal arteriovenous malformation (AVM) with a high-flow intradural fistula and prominent draining veins causing cord compression and congestive myelopathy. Conservative measures fail and neurosurgical intervention is indicated to isolate and obliterate the fistulous connection and draining veins.
The typical clinical workflow includes preoperative neurosurgical evaluation, detailed spinal angiography to map arterial feeders and venous drainage, multidisciplinary planning with neuroanesthesia and interventional neuroradiology if embolization is considered, operative microsurgical exposure of the cervical spinal cord, identification and disconnection/obliteration of the AVM/arteriovenous fistula, intraoperative neuromonitoring, hemostasis and closure, and postoperative intensive monitoring for neurological status and spinal cord perfusion. Procedural documentation includes indications, angio-anatomic findings, intraoperative steps, materials used (clips, sutures, embolic agents if applicable), estimated blood loss, neuromonitoring results, and postoperative plan including expected recovery and rehabilitation needs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons for a complex spinal AVM resection where both perform distinct portions of the operation. |