# 63650 lead trial placement



## vjefcoats

Hi!

Need some help with cpt 63650.  MD placed (2) leads 63650 and L8680 (16) electrodes for a medicare patient.  Also charging for 95972, 77003, 99144.
How would you post this per line item?

Thanks
Vicki


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## rkmcoder

You will probably have some of those codes denied.  77003 is bundled into 63650 and will probably be denied.  95972 is for programming of an implanted IPG, which is not done in a trial, and will probably be denied.  If it is not denied, it is because the insurance carrier did not realize that this was just a trial.  Be careful if you are billing L8680 sixteen times.  You only used two lead arrays and can only charge for two lead arrays, regardless of the number of leads within the arrays.  To answer your question, I would code this:

63650 x2
99144 x1
L8680 x2

Someone else may have a different opinion.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## vjefcoats

Thanks for replying back!.  I am new to PM coding but I coded ortho for past 3 years.  Do you know where I can get good info on PM coding especially 63650?


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## dwaldman

http://professional.medtronic.com/d...Billed_Codes_Combined_Jan_Feb_2010_NI9803.pdf

Here is a link for code reference for SCS procedures. 

Below is a link to live seminar on SCS coding at the end of April 

http://www.audioeducator.com/conference-Spinal-Cord-Stimulator-Coding-Changes-2010-280410

In regards, to L8680 Implantable neurostimulator electrode (with any number of contact points), each----I heard that you bill 1 unit for each contact or electrode----so 16 units I think would be correct. I don't bill for trials done in the office so I am not for sure

If you are billing in office setting, you can find out who the reimbursement guy is from the company that is supplying the leads for your region and they are paid to answer questions like this or deal with denials. You can request for them to come to the office and go over things and then you can use them as additional resource by email or phone.


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## marvelh

For Medicare, the code description for L8680 remains per electrode, so if your physician inserted 2 octrode leads in an office site of service, you would report L8680 x 16 BUT you would only report 63650 per lead inserted so 63650 x 2.

The HCPCS code description per electrode allows the multitude of different stimulator leads to be reported with 1 code rather than having to have a different code for quadripolar, octrode and the various brands.


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## MMAYCOCK

I agree with marvelh/CMS recently issued a clarification stating that L8680 describes electrode, each; so for Medtronic units which is what we use, 1 octrode equals L8680x8

The fee schedules list the payment by electrode, so you will lose quite a bit of revenue if you only bill for 1. 

Also, programming and analysis is needed in the trial units, so you should bill the 95972. It is payable with trial implantations. 

And the fluoro code for 63650 is 77002, not 77003. Even though it is bundled, I believe you should report it. 

Thanks,

Melanie


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## dwaldman

I talked to Medtronics Reimbursement and they use to have 77002 as applicable codes on the PDF for SCS procedures. They found out this was the not the correct code. Then they switched it to 76000. Then they no longer listed any fluoro code. When I called I asked them why they removed the fluoro codes. They said that they received information from NASS North America Spine Society that fluoro is inherent to SCS procedures and should not be listed separately. The only time I would suggest billing fluoro is if the physician would take the patient into the fluoro suite to look at the leads to see if they have migrated and this would post implanation and be billed with 76000. 77002 is for for fluoro used for  procedures in  areas other than the spine according to CPT Assistant.


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## rkmcoder

(These are my opinions and should not be construed as being the final authority.  Other opinions may vary.)

The way we code 63650 and the reasons behind it:

The initial part of a neurostimulator lead placement procedure (63650) is virually identical to an ESI, so the fluoro code would be the same as for an ESI, which would be 77003.  NCCI edits bundle 77003 into 63650, so billing it would make no sense.  77002 does not bundle into 63650, and I assume the reason for that is because 77002 is not the proper fluoro code for the procedure, hence no bundling.  76000 is not a needle localization code and should not be used at all for that purpose.  76000 does bundle into 63650, and I think that is because film could be taken at the end of the procedure to verify final lead placement, and 76000 would be that code.  Regardless, 76000 is bundled and should not be billed.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## dwaldman

Just clarifing when I said 76000 post implantation. I meant on a separate date of the implantation. Like 3 weeks later the patient comes in and the doctor uses the c arm to check to make sure the leads did not move. Then 76000 could be used.


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## rickik

*Cpt 63650*

Please Please Please
Can someone help me with where can I find the NCCI for 63650? 
my email address is rkozlowsky@neuropain.net
Thank you, Ricki Kozlowsky CPC


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## auburnlady7

*L8680 1 Lead with 8 electrodes*

Good Morning,

I am researching the correct way to bill for the L8680 for our pain clinic.  The doctor is implanting 1 lead array with 8 electrodes or contact points.  I have seen on different threads two different ideas of how to bill for this device.  One is that I would bill per electrode in my case would be 8 units and the other is bill per array which would be 1 unit.  During my research with website searches appears that this could have been an issue that the manufacturer disputed billing per array and the decision to bill per electrode/contact point was decided.  Can anyone verify what is correct currently per electrode or per array?  Thanks for any guideance we definitely appreciate


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## dwaldman

http://www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage

Click on Surgery: Endocrine, nervous, eye and ocular adenxa, auditory systems


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## dwaldman

As mentioned in another post in this thread  if you are billing for the supply and the procedure , bill per electrode with the L code to represent total number of electodes.  Also bill  63650 for placement and bill per array/lead placed.


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