# Hel with billing trial spinal cord stimulator



## MDPAYNE (Oct 5, 2010)

I'm new in pain management billing and i have an anesthesiologist that is getting into pain management. He has placed a trial spinal cord stimulator on a patient at the l1-2 level the electrode was passed into the epidural space and positioned. The stylette and needle were withdrawn. The same  was repeated on the left but a higher level of t12-l1 the leads were left and verified at the top of t8 .  Not sure how to bill this out. I'm thinking 63650 and 63650-59.


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## dwaldman (Oct 5, 2010)

63650 63650 51 modifier is how it is suggested in CPT Assistant and how for example WPS Medicare accepts. They state that 59 is for procedures that have CCI bundling issues. But the 59 might be neccessary if that is what certain carriers claim processing system require to prevent second line denial. I found the additional note is helpful stating Placement of Second Lead


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## MDPAYNE (Oct 6, 2010)

Thank you!


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## capricew (Oct 14, 2010)

I bill it this way  63650, 63650-59  to medicare all the time and never get denials.  The 51 modifier does not count on this procedure because this code is exempt from the 50% concurrent procedure payment reduction.

Medicare pays this code in full for both lines

hope this helps

caprice---cpc


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## dwaldman (Oct 14, 2010)

I bill it this way 63650, 63650-59 to medicare all the time and never get denials. The 51 modifier does not count on this procedure because this code is exempt from the 50% concurrent procedure payment reduction.

Medicare pays this code in full for both lines

hope this helps

caprice---cpc 

In response, maybe you are billing for a Hospital outpatient department or ASC where on the facility side 63650 is considered a device intenstive code where the mutliple surgery reduction does not apply. On the physician side, regardless if your carrier accepts the 59 modifier or in my case they request the 51, when you review the EOB you will that the second 63650 paid at 50 percent. This code is not 51 exempt and multiple surgery reduction applies on the physician side.


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