# Scs revision with laminectomy???



## kdsampson (May 6, 2016)

My provider is questioning me about how I'm coding his SCS revisions/removals. He places his stimulators via laminectomies, so when he has to go in and revise or remove an SCS I use 63662 or 63664. I don't bill for a revision laminectomy (63042) because my thinking is, if he placed it via laminectomy, it's a given that he would have to remove scar tissue, bony overgrowth, etc to get to the paddle lead. CCI doesn't bundle these codes, but it still doesn't seem correct to bill 63662 or 63664 with 63042 and I can't find anything that says either way. 

Has anyone had this question before? Can you point me to a reference or resource?

Thanks!

Kimberly


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## dwaldman (May 7, 2016)

Below is from AMA CPT Change 2010, as seen below CPT 63664  includes the work of:

 "Scar tissue and additional bone removal around the prior laminectomy site, along with dissection of the epidural space, are performed to access and remove the preexisting paddle lead in the epidural space via gentle traction. A new paddle lead is placed through this laminectomy site using fluoroscopic guidance"

Clinical Example (63664)

A 56-year-old female underwent a previous implantation of a dorsal column spinal stimulator for pain control, which provided good coverage and control of pain in the affected area. The lead has fractured, and the stimulator no longer provides coverage to the affected area. The plate/paddle electrode is to be removed and replaced to once again cover the affected area.

Description of Procedure (63664)

Under anesthesia, the anchoring site of the previous stimulator lead in the thoracolumbar spine is localized. The overlying soft tissue structures are anesthetized to the level of the lamina. A midline incision is created, and soft tissues are dissected to expose the lead. Scar tissue and additional bone removal around the prior laminectomy site, along with dissection of the epidural space, are performed to access and remove the preexisting paddle lead in the epidural space via gentle traction. A new paddle lead is placed through this laminectomy site using fluoroscopic guidance. The exposed end of the electrode array is attached to an external stimulator unit. Under guidance from the surgeon, a technician out of the operating field tests various electrode combinations, and the lead is physically relocated by the surgeon until the patient indicates that the dermatomal areas of her typical pain have been covered with paresthesias generated by the stimulator. (Note: Insertion or replacement of the implanted spinal neurostimulator pulse generator or receiver is a separately reportable procedure [CPT code 63685]). The paddle lead is attached to the neurostimulator pulse generator or receiver electrode connectors. The lead is anchored to the fascia. An image is obtained to document final placement. The incision is closed, and the sites are dressed.

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In contrast, CPT 63042  Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar  is only reported for excision of a recurrent disc herniation that has been previously excised. It would be inappropriate to use this code when CPT 63664 describes the work of revision laminectomy/laminotomy for SCS stimulator procedures.

Below is from NASS/North American Spine Society Coding Q &A

63040-63044
"These codes are used for re-exploration discectomy procedures performed at the exact same level(s) as the previous procedure."

"How do you code for a repeat lumbar laminectomy of recurrent spinal stenosis? Can I use 63042?

"A repeat laminectomy for stenosis is coded using the laminectomy codes (63047, 63048). Code 63042 (Laminotomy(hemilaminectomy), with decompression of nerve root(s), including partial facectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace, lumbar) is only coded for repeat discectomy, if the repeat laminectomy includes a repeat discectomy the code 63042 may be reported."

Below is from the AMA

CPT Changes: An Insider's View 2001 states: "Codes 63040-63044 are the only codes that may be reported for procedures performed on a recurrent herniated nucleus  each previously explored cervical or lumbar interspace. The term ‘reexploration' simply relates to the repeat surgical exposure of a previous surgical tract and target at the same site on the same patient at a time after an initial surgical procedure(s) was performed. As with other CPT code descriptors, the timeframe associated with the reexploration procedure is not specifically stated."


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## kdsampson (May 9, 2016)

Thank you very much for the references. They are very helpful. I knew there had to be something out there, but just couldn't find it. 

Kimberly


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