CPT® Code 63066

Add-On Code

Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (List separately in addition to code for primary procedure)

The procedure described by CPT® Code 63066 refers to a surgical intervention performed via a costovertebral approach, specifically targeting the thoracic region of the spine. This approach is utilized for the decompression of the spinal cord or nerve roots, particularly in cases involving conditions such as herniated intervertebral discs. The term 'costovertebral' indicates that the surgery involves both the vertebrae and the ribs, as the procedure necessitates partial excision of a rib and removal of the transverse process on the affected side. This surgical technique allows for the creation of a ventral window, which is essential for visualizing and accessing the spinal cord and nerve roots during the operation. The transverse processes, which are bony projections extending laterally from the vertebrae, play a crucial role in this procedure. In the thoracic spine, these processes are notably longer and more robust than in other spinal regions, and they articulate with the ribs. The surgical process begins with a semilunar skin incision made over the thoracic spine, which is then extended to expose the posterior aspect of the rib. Following this, the surrounding soft tissue and muscles are carefully dissected to reveal the rib and transverse process. The surgical team elevates the paraspinal muscles to access the spinous process, lamina, and transverse process, allowing for the necessary exposure of the lamina and facet joint. Once the area is adequately exposed, a high-speed drill is employed to remove a portion of the rib and transverse process, thereby creating a window through which the spinal cord and nerve roots can be accessed. The procedure involves careful examination of the intervertebral disc, where any herniation is identified. The surgeon will excise bone spurs and create a cavity to facilitate the removal of any ruptured disc fragments or bulging nucleus pulposus that may be compressing the spinal cord or nerve roots. Additional bone may be removed as required to alleviate pressure on the affected nerves. After ensuring that any bleeding is controlled, the surgical wound is meticulously closed in layers. This code is specifically used for each additional thoracic vertebral segment involved in the procedure, following the primary procedure code.