# Spinal cord stimulator - I have a situation



## frankmmedbiller (Aug 9, 2012)

I have a situation where one doctor inserted the leads and one doctor inserted the pulse generator.  This is being billed to a workers comp carrier they denied the claim saying bill must be pro-rated with another provider.  Are there seperated codes for the insertion of the leads and the insertion of the pulse generator?  Please help


----------



## mcnaryk (Aug 10, 2012)

*nerve stimulator*



frankmmedbiller said:


> I have a situation where one doctor inserted the leads and one doctor inserted the pulse generator.  This is being billed to a workers comp carrier they denied the claim saying bill must be pro-rated with another provider.  Are there seperated codes for the insertion of the leads and the insertion of the pulse generator?  Please help



Hi Frankmmedbiller:

No, there are not seperate codes for the leads vs. the pulse generator: the codes 63650-63688 describe ALL of the work, not just individual parts. I've never seen a nerve stimulator procedure that needed 2 surgeons-that's pretty unusual and therefore probably why the work comp is denying. If you have a rep for the nerve stimulator company that provides your units I would check with them-ours was a big help with billing questions. But I really don't think you can unbundle the charges on here-only 1 doctor should be billing for this. Good luck!


----------



## frankmmedbiller (Aug 10, 2012)

Thank you for your input


----------



## dwaldman (Aug 10, 2012)

"Code 63685 should be reported in addition to code 63650 to describe the implantation of the pulse generator and percutaneous electrode array connection. "

Above is from AMA CPT Assistant Apr 2011

I believe due to complications that can happen with the skin pocket created for the internal pulse generator, you might be describing a case where the physician that placed the trial/temporary leads also wanted to be the physician who placed the permanent leads but elected to have a separate physician create the skin pocket and assist with tunneling the leads to connect to the internal pulse generator due to the other physician has more experience with this portion of the procedure.

If one physician placed the leads/arrays that were placed percutaneously, the CPT would be reported per lead/array placed: 

63650 Percutaneous implantation of neurostimulator electrode array, epidural

If another provider placed the internal pulse generator and connected the leads/arrays, the CPT would be:

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


----------



## rebeccacumley (Aug 25, 2012)

*Stim implant*

Dwaldman is correct.


----------

