# IPG replacement with change of pocket site



## celcano (Mar 21, 2017)

Good afternoon.  My physician replaced a SCS generator (636850.  However, he moved the pocket from the left side to the right side.  Can I bill anything in addition to the 63685?
Thank you for your assistance.


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## dwaldman (Mar 23, 2017)

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

63688  
Revision or removal of implanted spinal neurostimulator pulse generator or receiver  

From Optum Encoder

"Code 63685(column 1) has a CCI conflict with code 63688(column 2). A modifier is allowed to override this relationship"

When reviewing the code pair 63685 and 63688, NCCI (National Correct Coding Initiative), NCCI/CMS has CPT 63688 as a column two code within the bundling edit.  The edit is for removal of old device and replacement of new generator/battery within the same side/pocket. In that case the removal would be inherent and not separately reported. But there is an instance, where modifier 59  is allowed but only when the IPG (Internal Pulse Generator) is removed from  the lower trunk and Brand New IPG is placed on the contralateral side. In that case, CMS/NCCI has granted the use of modifier 59 with CPT 63688 , to support that the following transpired:

1). A new Internal Pulse Generator is being placed to support the use of CPT 63685.
2). The previous placed device is removed and in a separate location, a new skin incision is performed to place the new battery.

The clinical relevance is the patient and physician agree the patient would benefit from having the new device place in newly created pocket on the contralateral side.

Below is from the NCCI policy Manual for 2017

 CHAPTER VIII SURGERY:  ENDOCRINE, NERVOUS, EYE AND OCULAR ADNEXA, AND AUDITORY SYSTEMS CPT CODES 60000 - 69999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES  

https://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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## celcano (Mar 23, 2017)

Thank you so much.  That was great explanation.


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