How To Use CPT Code 63704

CPT 63704 describes the repair of a birth defect known as myelomeningocele, which is a severe form of spina bifida. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 63704?

CPT 63704 can be used to describe the repair of a myelomeningocele, a birth defect where the spinal membrane and spinal cord protrude through a defect in the vertebral column. This code is specifically used when the diameter of the myelomeningocele is less than 5 cm.

2. Official Description

The official description of CPT code 63704 is the repair of myelomeningocele with a diameter less than 5 cm.

3. Procedure

1. The provider makes an incision adjacent to the myelomeningocele, typically in the lumbar or sacral areas of the lower back.
2. The incision is extended into the sac, avoiding neural structures.
3. The provider mobilizes the nerve roots that extend into the spinal canal and removes any nerve roots terminating in the sac if necessary.
4. The edges of the neural folds are sutured together to restore the normal structure of the spinal cord.
5. The provider identifies the filum terminale, the point at which the spinal cord terminates, and cuts the connective tissue to release the associated connection.
6. The dura membrane is dissected from the connective tissue.
7. A watertight closure of the dural defect is performed, and the closure is reinforced by suturing in the paravertebral muscles and tissue.
8. Small subcutaneous drains may be placed along the patient’s flank.
9. The skin is sutured in layers, and a sterile dressing is applied to the wound.

4. Qualifying circumstances

CPT 63704 is performed on patients with a myelomeningocele, a birth defect where the spinal membrane and spinal cord protrude through a defect in the vertebral column. This code is specifically used when the diameter of the myelomeningocele is less than 5 cm.

5. When to use CPT code 63704

CPT code 63704 should be used when performing the repair of a myelomeningocele with a diameter less than 5 cm. If the diameter is greater than 5 cm, CPT code 63706 should be used instead.

6. Documentation requirements

To support a claim for CPT 63704, the provider must document the following information:

• Patient’s diagnosis of myelomeningocele
• Diameter of the myelomeningocele
• Date of the procedure
• Details of the procedure, including the incision, mobilization of nerve roots, closure of dural defect, and any additional steps taken
• Use of magnification, if applicable

7. Billing guidelines

When billing for CPT 63704, ensure that the procedure performed meets the criteria for this specific code. It is important to accurately document the diameter of the myelomeningocele to support the use of this code. Additionally, be aware of any specific billing guidelines or modifiers that may be required by the payer.

8. Historical information

CPT 63704 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs the repair of a myelomeningocele with a diameter less than 5 cm on an infant.
2. A surgeon performs the repair of a myelomeningocele with a diameter less than 5 cm on an adult patient.
3. A neurosurgeon performs the repair of a myelomeningocele with a diameter less than 5 cm on a pediatric patient.
4. A provider performs the repair of a myelomeningocele with a diameter less than 5 cm on a pregnant patient.
5. A pediatric surgeon performs the repair of a myelomeningocele with a diameter less than 5 cm on a newborn.
6. A neurosurgeon performs the repair of a myelomeningocele with a diameter less than 5 cm on a geriatric patient.
7. A provider performs the repair of a myelomeningocele with a diameter less than 5 cm on a teenager.
8. A surgeon performs the repair of a myelomeningocele with a diameter less than 5 cm on a young adult.
9. A neurosurgeon performs the repair of a myelomeningocele with a diameter less than 5 cm on an elderly patient.
10. A provider performs the repair of a myelomeningocele with a diameter less than 5 cm on a middle-aged patient.