# Dorsal column stimulator coding



## Kmatney (Dec 8, 2009)

I have a question regarding the billing of the placement of the generator after the initial lead placement (trial) was successful.  If the physician leaves the lead in place from the initial trial, and only connects the extensions to the lead to connect it to to the generator, can you only charge for the generator placement, 63685?   It is not actually a lead revision, nor did he remove and re-insert another lead.   
Thank you.
Kim


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## Walker22 (Dec 8, 2009)

I would be very surprised if the same leads were used for both the trial and the perm implant. The leads for the trial have to extend to the exterior of the patients body to connect to the test unit. Surely the surgeon doesn't then implant these non-sterile leads into the patients body during the perm! We always place new leads.

Anyway, as to your original scenario, you would not be able to bill for a lead revision in the case you describe.


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## Kmatney (Dec 9, 2009)

In most cases the patient is seen in the office and the temp leads are removed, but in this case the patient had the temp, then the perm implant the next day.  The procedure states an incision was made over the original lead and a new extension was placed and tunneled to the generator pocket, which another extension is placed and connected to the generator.  It does not state anything about a new "electrode paddle" being placed, only the extensions.  Due to the tunneling of the new "part" of the lead, would this be considered a revision?


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## Walker22 (Dec 9, 2009)

My initial reaction to this would be that no, this does not qualify as a revision. I think the main RVU values for the revision code are for having to realign existing leads that may have slipped out of place. You might want to consult with the manufacturer's reimbursement specialist. Anyone else have anything to add?


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## Kmatney (Dec 13, 2009)

Thank you for your help walker22.  That was my initial thinking as well. I really despise billing unlisted codes, but that seems it may be my only option.


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## Walker22 (Dec 14, 2009)

You're welcome!


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