# CPT codes to use for SCS Revision



## laurenwilcox10 (Jul 21, 2015)

Need assistance on what CPT codes to use on this SCS Revision procedure, including if a modifier would be required. The provider removed 2 precision batteries and then installed a new spectra generator and worked on the leads. The payer is Medicare Part B primary, secondary Medicaid. Would I be able to use CPT 63688 (Revision/removal of implanted spinal neurostimulaor pulse generator or receiver) and CPT 63685 (insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) together? *Note (Do not report 63685 in conjunction w/63688 for the same pulse generator or receiver)  Can I use CPT 63688, 63685 and 63663 with 95972? Please advise. 

Procedure Note:
1. Removal of Internal Pulse Generator x 2
2. Revision of Generator Pocket
3. Implantation of new internal pulse generator/Boston Sci Spectra  
4. Use of fluroscopy for radiographic guidance
5. Interpretation of radiographic pictures

Op Description: the patient was brought to the operating room and was placed in the prone position. The patient's skin was prepped and drapped from the upper thoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were identified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthesized wih a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicarb. This previous generator pocket incision was opened using a 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 implanted leads. The patient was woken from sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. The patient did receive adequate paresthesias in the neck and upper extremities. The patient stated that the stimulation was much better than the previous generator and there was better coverage in the pain pattern. The patient then elected to have generator changed to the new Boston scientific precision spectra internal pulse generator. The previously implanted generator for the thoracic system was identified with fluroscopic guidance. The pocket was anesthetized and was opened using sharp and blunt dissection. The previously implanted generator was removed in its entirety. A tunneling device was then used to connect this pocket to the pocket that had been created for the cervical stimulator system. The extension set that had or even connected to the previously implanted cervical stimulator leads was passed through the tunneling device in to the pocket that had been created for the thoracic system. The previous generator pocket was then revised in order to accommodate the new generator along with the use of 2 extension sets. The new generator was interrogated. All of the connections were verified and impedances were checked. The previous cervical generator pocket and the newly revised lumbar pocket were then washed out with a generous amoint of solution containing vancomycin.    

Thank you.


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## dwaldman (Jul 22, 2015)

In order to report CPT 95972, the provider would have to document that he personally performed the reprogramming and which parameters were reprogrammed. For CPT 95971, this would include 3 or fewer parameters. CPT 95972 would be more than 3 parameters. But if this was provided by the manufacturer's representative then it would not be separately reported. Impedance testing is not reported with code series 9597X.
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http://www.bostonscientific.com/en-US/reimbursement/neuromodulation/physicians.html

Below is description of 9592X requirements that I copy and pasted from the Boston Scientific website.

Neurostimulator Analysis & Programming: The AMA CPT has defined simple intraoperative or subsequent programming of neurostimulator pulse generator with code 95971 when there are changes to three or fewer of the following parameters: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time, or more than one clinical feature. Complex intraoperative or subsequent programming is defined as changes in more than three of the parameters above (codes 95972-95973). 

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Below is from the CMS NCCI policy manual. The op report was a little hard for me to follow, what they describe below is if the generator is removed from one side of the body. And then a new generator is placed in separate location then the removal then both CPT 63685 and CPT 63688 (modifier 59) can be reported. If the generator is removed then a new generator is placed in the same pocket then only CPT 63685.

There does seem to certain degree of revision to the current leads and I believe it could support CPT 63663 with the extension being added.



http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html



16. 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.


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