# Spinal Cord Stimulator Revision



## laurenwilcox10 (Mar 18, 2015)

Need assistance on making sure I am coding SCS Revision correctly. I want to know if I should use as primary code 63663 and as 2nd code 63685 on this particular revision. This was appears to be similar like the other revision I posted yesterday. Based on this procedure I was advised elsewhere to actually use 63650 as the primary and then 63688 as the 2nd code, so I am not sure. This is a Medicare patient so I was advised a modifier would not be necessary.  Procedure done was:

Removal of Internal Pulse Generator
Implantation of 8 contact SCS lead
Revision of Generator Pocket
Implantation of New Internal Pulse Generator
Use of fluroscopy for radiographic guidance
Interpretation of radiographic pictures

OP Description:  Patient was brought to the operating room and was placed in the prone position. The patients skin was prepped and drapped from the midthoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were indentified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthetized with a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicarb. This previous incision was opened using blunt and sharp dissection. The capsule surrounding the internal pulse generator was identified and opened. The generator was dissected out and retention suture was removed. The pulse generator was then removed from the pocket and removed in its entirety. The previous leads were disconnected from the generator. A testing cable was then connected to the previously implnated leads. The pateint was woken from sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. Patient did not receive adequate paresthesias in the lower back as well as the left lowere extremity. Patient was placed back under sedation. Under fluro guidance at the L1/2 level was accessed with a 14ga coude needle using a loss of resistance technique. An additional 8 contact lead was hen advanced through the needle to the level of mid T7 and to the left of midline. Patient was then woken from sedation and tesing again. Patient stated that the stimulation was much better than previous generator and there was better coverage in pain pattern. Patient then elected to have generator changed to the new Boston Scientific precision spectra internal pulse generator. The previous generator pocket was then revised in order to accomadate the new generator. A tunneling tool was used to place the new lead into the new generator pocket. The previously implanted lead and the new lead were then connected to the new generator. The new generator was interrogated. All of the connections were verified and impedances were checked.         

Appreciate your help on this request.
lwilcox


----------



## dwaldman (Mar 19, 2015)

As seen below, if a previously placed percutaneous/permanent lead (63650) is being replaced, the correct CPT code is 63663. If 2 leads are being replaced, due to CPT 63663 plural descriptor array(s), only one unit of CPT 63663 is reported. 

After reading the report twice, what is being described is 2 leads being disconnected from the generator, a new generator placed and a 3rd lead placed without removal of the 2 other leads. I agree that it does not appear that the 2 previously placed leads were revised due to malposition, but simply an additional lead was placed, so I agree that CPT 63650 could be used in the scenario you provided. I have had trouble obtaining an answer regarding when a generator is moved to the contralateral side and the existing leads are disconnected and re-tunneled and re-connected if this is also considered a revision under CPT 63663.


August 2010 page 8

Pain Medicine Clarification 

Code 63663, Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed, is reported to describe the revision or replacement of a previously placed percutaneous (permanent, internalized system) electrode array (code 63650). 



If you are replacing the generator the CPT code is CPT 63685. The code descriptor specifically states it includes "replacement" CPT 63688 is reserved for removing the device or revising the location of the pocket but retaining the existing device. In the CMS NCCI policy manual, they state that CPT 63685 is reported for a replacement. They allow CPT 63688 with modifier 59 if one device is removed and then a new device is placed in separately created pocket. Which in your case was not done so only the replacement code would be reported. 

As seen below the code descriptor for CPT 63685 includes "replacement"

63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling 

Below is from the NCCI policy manual:

6. The following information was revised and published April 1, 2012.  CPT codes 61885, 61886, and 63685 describe ?insertion or replacement? of cranial or spinal neurostimulator pulse generators or receivers.  Reporting an ?insertion or replacement? CPT code necessitates use of a new neurostimulator pulse generator or receiver.  CPT codes 61888 and 63688 describe ?revision or removal? of cranial or spinal neurostimulator pulse generators or receivers.  If the same pulse generator is removed and replaced into the same or another skin pocket, the ?revision? CPT code is the only CPT code that may be reported.  The ?replacement? CPT code which requires use of a new neurostimulator pulse generator or receiver should NOT be reported as this Manual previously indicated.  If one pulse generator is removed and replaced with a different pulse generator into the same or another skin pocket, the ?replacement? CPT code may be reported.  The ?removal? CPT code is not separately reportable.  The ?insertion or replacement? CPT code is separately reportable with a ?revision or removal? CPT code only if two separate batteries/generators are changed.  For example, if one battery/generator is replaced (e.g., right side) and another is removed (e.g., left side), CPT codes for the ?insertion or replacement? and ?revision or removal? could be reported together with modifier 59


----------

