# Removal of Spinal Cord Stimulator paddle and Leads



## companey (May 7, 2018)

Hello All,

I was asked a question from my staff and I was wondering what you thought.  They Physician did the following two procedures and the office billed CPT 63661 with 2 units and 63662.  Medicare processed 63662 but denied 63661 with 2 units.  The office removed the 2 units and billed the 63661 with 1 unit.  Medicare has denied "That single line item claim is now being denied because it requires a qualifying service to be done."

Please see the OP Note that I Received below

Postoperative Diagnoses:
1. Status Post Spinal Cord Stimulator implant with another provider
2. Failed back syndrome
3. Nonfunctioning spinal cord stimulator

Procedures Performed:
1. Removal of spinal cord stimulator paddle and leads
2. Via a separate incision removal of spinal cord stimulator battery pack

Description of Procedure:  The patient was brought to the operating suite. She was placed under general anesthesia. Patient was flipped from supine to prone onto a chest, hip, thigh Jackson table, arms up in a superman position, all padded pressure points secured.  X-ray fluoroscopy was brought in to draw out the midline paraspinal lumbar and the battery pack incisions that hopefully we would have to utilize, but we also drew out a thoracic incision in case we have to do a laminectomy if the leads were stuck.  We infiltrated both incisions with Marcaine with Epinephrine. Preoperative antibiotics were given. Proper time-out was performed. Patient was prepped and draped in sterile fashion.
The lumbar incision para-midline was opened first and we used blunt dissection techniques to get the fascia, got down to the spinal cord leads.  They were stapled in place, we removed that.  We extracted leads from the thoracic epidural space and there was no rush of CSF and they came out easily.  We cut those.  We irrigated that wound with bacitracin infused saline. We closed the wound in anatomic layers with 0 Vicryl to the muscle, 0 Vicryl to the fascia, 2-0 Vicryl to the dermis, and Steri-Strips for the skin. Sterile dressing was applied.
Removal of spinal cord stimulator battery pack via separate incision: We made a separate incision in the left buttock area, dissected down to the capsule of the battery pack.  We found the leads that we had cut earlier and pulled those through the tissues and the spinal cord stimulator was removed in its entirely, verified by x-ray.  We extracted the battery out of the pack and copiously irrigated with bacitracin infused saline.  We did essential tack up after assuring hemostasis to get the pocket to close down.  We closed the wound in anatomic layers, 0 Vicryl for the fascia, 2-0 Vicryl for the dermis, and steri-strips for the skin.  A sterile dressing was applied there.  the patient was rolled from prone to supine and extubated without incident.


Was CPT 63661 and 63662 correct and should there be a modifier??

Thank You!!!  It has been awhile since I have done Orthopedic.


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## mbassett5 (May 8, 2018)

I would have coded it:

63688 x 1 - Revision or removal implanted spinal neurostim generator
63661 x 1 - Removal spinal neurostimulator percutaneous electrode array(s)

I would not have coded 63662 because the doctor did not have to perform a laminectomy. He stated "drew out a thoracic incision in case we have to do a laminectomy if the leads were stuck." But the leads were removed easily and a laminectomy was not needed. 

63661 only allows 1 MUE because the description states array(s) 
63688 would be the qualifying procedure

Hope this helps
Michelle Bassett, CPC, CPMA, CPB


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## companey (May 8, 2018)

Thank You it does help!!!  I appreciate the answers and why you would code that way.  
I hope you have a great day!!!
Jessica


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