Summary & Overview
CPT 63276: Excision of Thoracic Extradural Spinal Lesion
CPT code 63276 represents an operative neurosurgical procedure to remove part of a thoracic vertebra and excise an extradural spinal cord lesion, with tissue submitted for pathology. This code captures a complex, site-specific spinal excision that has implications for surgical coding, payer coverage determinations, and reimbursement at the national level given its association with high-acuity hospital-based care. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise overview of the clinical context for coding 63276, common settings of care, and the types of documentation elements that typically support billing (operative description, lesion location, and pathology submission). The publication outlines common modifier usage patterns and payer-specific considerations where available. It also provides benchmarking context and policy notes relevant to facility and professional claims processing. Data not available in the input is clearly indicated when payer-specific rates, associated taxonomies, or ICD-10 mappings are not provided. This content is intended for coding professionals, billing managers, and policy analysts seeking a national-level summary of CPT code 63276 and its operational implications in hospital-based neurosurgical services.
Billing Code Overview
CPT code 63276 describes a surgical procedure in which a provider removes part of a thoracic vertebra and excises an extradural spinal cord lesion, with a portion of the lesion sent for pathologic testing. Extradural indicates the lesion is located outside the dura mater, the tough outer membrane surrounding the central nervous system.
Service type: Operative spinal procedure / neurosurgical excision of extradural thoracic lesion
Typical site of service: Inpatient hospital operating room or specialized surgical suite
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents with progressive thoracic back pain, unilateral lower-extremity radiculopathy, and signs of spinal cord compression on MRI showing an extradural thoracic mass at T6–T7. Conservative measures failed and neurologic function is declining. The surgical team schedules a thoracic laminectomy with excision of the extradural lesion and intraoperative frozen section and permanent pathology specimens sent to pathology. The typical workflow includes preoperative imaging review, informed consent documenting risks (bleeding, infection, neurologic deficit), general anesthesia with prone positioning, a thoracic midline exposure, partial or complete laminectomy of the involved vertebrae, microsurgical excision of the extradural tumor, hemostasis, specimen submission, layered closure, and postoperative inpatient neurologic monitoring and pain management. The typical site of service is an inpatient acute-care hospital or an ambulatory surgery center when appropriate, performed by a neurosurgeon or orthopedic spine surgeon with perioperative support from anesthesiology, intraoperative neuromonitoring, and surgical pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when intraoperative complexity or work effort substantially exceeds usual for 63276. |