How To Use CPT Code 63707

CPT 63707 describes the repair of a dural or cerebrospinal fluid (CSF) leak that does not require a laminectomy. 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 63707?

CPT 63707 can be used to describe the surgical repair of a tear in the dura, the tough outer membrane surrounding the central nervous system, that causes a cerebrospinal fluid (CSF) leak. This procedure is necessary to prevent serious infections and may be performed after spinal or intradural surgery, trauma, or due to a congenital abnormality.

2. Official Description

The official description of CPT code 63707 is: ‘Repair of dural/cerebrospinal fluid leak, not requiring laminectomy.’

3. Procedure

1. The provider begins by carefully locating the dural breach through imaging studies.
2. The patient is appropriately prepped and anesthetized.
3. The provider makes an incision over the site of the dural tear and dissects down to the tear.
4. If any cause of the tear, such as a sharp piece of bone, is found, the provider removes it.
5. If there is no breach in the dura, the provider closes the tear with a watertight primary closure by tightly reapproximating the wound edges and suturing.
6. If the tear is large or the dura is thin, the provider prepares a tissue graft or a synthetic dural substitute to create a watertight seal.
7. If the tear is in an inaccessible location, the provider may place the graft into the defect and tack it down to prevent displacement.
8. Once a watertight seal is ensured, the provider closes the incision in layers and applies sterile dressings.

4. Qualifying circumstances

CPT 63707 is performed when there is a tear in the dura causing a cerebrospinal fluid leak. This can occur after spinal or intradural surgery, trauma, or due to a congenital abnormality. The procedure does not require a laminectomy.

5. When to use CPT code 63707

CPT code 63707 should be used when a repair of a dural or cerebrospinal fluid leak is performed, and a laminectomy is not required. It is important to accurately document the procedure and ensure that it meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 63707, the following documentation is required:

• Imaging studies confirming the dural breach
• Preparation and anesthesia details
• Description of the surgical technique used
• Findings during exploration and repair
• Details of the closure method, including primary closure or graft placement
• Confirmation of a watertight seal
• Incision closure and dressing application

7. Billing guidelines

When billing for CPT 63707, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the procedure and any additional services provided. Modifier 78 should be appended if the repair occurs within the global period of the original spinal or dural surgery. If the surgeon performing the repair is not the original surgeon or a partner, the modifier should not be appended.

8. Historical information

CPT 63707 was added to the Current Procedural Terminology system on January 1, 1990. The code description was changed on January 1, 2002, to specify that a laminectomy is not required. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes spinal surgery and develops a dural tear. The provider performs a repair of the dural leak without requiring a laminectomy.
2. After a traumatic injury, a patient presents with a cerebrospinal fluid leak. The provider performs a repair of the dural tear without the need for a laminectomy.
3. A patient is born with a congenital abnormality causing a cerebrospinal fluid leak. The provider performs a repair of the dural tear without requiring a laminectomy.
4. Following intradural surgery, a patient experiences a dural tear and cerebrospinal fluid leak. The provider performs a repair of the dural leak without the need for a laminectomy.
5. A patient undergoes a spinal procedure and develops a dural tear. The provider performs a repair of the dural leak without requiring a laminectomy.
6. After a traumatic accident, a patient presents with a cerebrospinal fluid leak. The provider performs a repair of the dural tear without the need for a laminectomy.
7. A patient is diagnosed with a congenital abnormality causing a cerebrospinal fluid leak. The provider performs a repair of the dural tear without requiring a laminectomy.
8. Following intradural surgery, a patient experiences a dural tear and cerebrospinal fluid leak. The provider performs a repair of the dural leak without the need for a laminectomy.
9. A patient undergoes spinal surgery and develops a dural tear. The provider performs a repair of the dural leak without requiring a laminectomy.
10. After a traumatic injury, a patient presents with a cerebrospinal fluid leak. The provider performs a repair of the dural tear without the need for a laminectomy.