# pain management 63688



## kimcpccircc (Oct 17, 2011)

Can anybody help me? new pain management doctor to my practice.

synchromed pump removal: dr says 63688; 11042; 77003-26

prep/drape etc: could not feel it at this point, fluoroscopy was used and were able to pick up the extension leads. Bovie dissectin carried down the subcutaneous tissue and the leades were removed. We noticed that the marking site was exactly where we placed the fluoro. Small incision was created and two boots were pulled inth the incision, were pulled inth the field. A second incision was necessary to remove the electrode leads. These were pulled down and clipped close to the skin, retracted deep into the subcu. The extension leads were then removed in toto. The generator was removed and given to Medtronic rep. Then closure. Used the term capsulotomy when removing the tissue attached these leads and says 11042.

can anybody help? I see: 63688 and 63661-51.

Thanks in advance!! Kim


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## dwaldman (Oct 19, 2011)

Below states fluroscopy is not separately reportable with 63661 from January 2010 AMA CPT Assistant.

"CPT codes 63661-63664 distinguish the work involved in the revision or removal of percutaneous electrodes in comparison to the revision or the removal of a plate/paddle electrode array placed via laminotomy or laminectomy. These procedures may be performed with the assistance of fluoroscopic guidance, which is considered an inclusive component and not separately reported. However, fluoroscopic guidance is not always required to perform these procedures, the phrase “when performed” is in the descriptors of codes 63661-63664. Revision, including replacement code 63664, is not reported in conjunction with removal codes 63661 and 63662, when performed for the same spinal level (cervical, thoracic, lumbar, and sacral)."

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In the descriptor it states "including fluorscopy" similiar to the term "with image guidance" indicates that fluoroscopy is not separately reportable.

Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed

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Below is the lay description from encoder, it does not describe the removal of scar tissue from the leads another option instead of reporting 11042 is 63661 with the 22 modifier if it was indicated in the procedure note that there was increase work involved than what is normal felt required to remove the leads and payer can determine additional payment. I have never seen 11042 as a suggestion for removal of scar tissue, so I am not aware of the stance on if removal of scar tissue is consider inherent to reporting 63661 or not.

"The physician removes spinal neurostimulator electrode percutaneous arrays (63661) or spinal neurostimulator plates or paddles that were placed via laminotomy or laminectomy (62662). The patient is face down (prone). The physician makes a midline incision overlying the affected vertebrae. The fascia is incised. The paravertebral muscles are retracted. The physician removes the electrode plates or paddles in the epidural space proximate to the spine segment. Stimulation is applied. These codes include the use of fluoroscopic guidance, when performed"


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