Summary & Overview
CPT 63252: Resection/Obliteration of Thoracolumbar Spinal Arteriovenous Malformation
Headline: CPT code 63252: Surgical treatment of thoracolumbar spinal arteriovenous malformation
Lead: CPT code 63252 denotes a neurosurgical procedure to remove or close abnormal communications between arteries and veins (arteriovenous malformation, AVM) located within, on, or near the thoracolumbar spinal cord. The intervention targets fistulae and draining veins to correct neurological deficits such as lower extremity weakness and to halt disease progression.
Why it matters: Spinal AVMs are uncommon but potentially disabling vascular lesions. Accurate coding for CPT code 63252 matters for appropriate clinical documentation, resource planning, and uniform reporting across payers. This code captures a high-complexity neurosurgical vascular service that typically involves specialized surgical teams and perioperative care.
Payers covered: Analysis includes major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides a concise overview of the clinical service represented by CPT code 63252, common billing considerations, and the payer landscape. Readers will find benchmarks and policy context where available, guidance on typical sites of service and service line classification, and clinical context that informs billing and utilization. Data not available in the input are identified explicitly when present.
Billing Code Overview
CPT code 63252 describes a neurosurgical procedure to remove or occlude arteriovenous malformations (AVMs) located within, on, or near the spinal cord in the thoracolumbar spine. The procedure isolates and eradicates the fistula and draining veins to address functional abnormalities such as lower extremity weakness and to prevent progression of the condition.
-
Service type: Surgical excision or obliteration of spinal arteriovenous malformation (neurosurgical vascular intervention)
-
Typical site of service: Inpatient or outpatient hospital operating room or specialized surgical center for spine neurosurgery
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with progressive bilateral lower extremity weakness, gait instability, and intermittent radicular back pain. MRI of the thoracolumbar spine and spinal angiography confirm a spinal cord arteriovenous malformation (AVM) with high-flow fistulous connections and dilated draining veins compressing the cord. The multidisciplinary team (neurosurgery, interventional neuroradiology, anesthesiology) schedules a surgical obliteration of the intradural AVM at the thoracolumbar level.
Preoperative workflow includes detailed neurologic exam documentation, informed consent describing risks (bleeding, neurological deficit, infection), pre-op angiographic mapping, and medical optimization. Intraoperatively, the surgeon performs a laminectomy or limited exposure of the thoracolumbar cord, microsurgical dissection to identify feeding arteries, obliteration or resection of the nidus and fistula, and coagulation or ligation of draining veins. Intraoperative neuromonitoring and possible intraoperative angiography are used to confirm obliteration. Postoperative care involves neurologic checks, ICU or step-down monitoring for hemodynamics and neurologic changes, pain control, and follow-up imaging to confirm durable exclusion of the AVM and recovery of function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When this code is the primary surgical service performed during the encounter |