# Trial Placement of 2 Perc Spinal Neurostimlator Electrode(s)



## joanne71178 (May 17, 2013)

Do I code 63650 once or twice?  
63650
63650-59?

"After identification of the appropriate structures with fluoroscopic guidance the area was prepped Utilizing Povidone-Iodine Antiseptic/Germicide Swabsticks and draped in the appropriate sterile fashion.  18 mLs of 1% Preservative Free Lidocaine was drawn.  9mLs was used to anesthetize superficial and deep tissues after negative aspiration. 

Following appropriate time for anesthetic effect, and under fluoroscopic guidance the Right L2 pedicle was identified and a 14g 3.5 inch Epidural needle was advanced tangentially into the epidural space at Right T12-L1, using a loss of resistance to sterile water technique.  No CSF or blood was noted.  *The Boston Scientific Lead was then introduced through the epidural needle without difficulty.  W=Under direct AP visualization the lead was then advanced to the target location of Right T7.  *

Starting at the Pedicle of Left L2 a second 14g 3.5 inch Epidural needle was advanced intot he epidural space at Left T12-L1 using the same tangential approach and loss of resistance to saline technique.  No CSF or blood was noted.  Confirming appropriate needle placement with AP and lateral views.  *The Boston Scientific Lead was then introduced through the epidural needle without difficulty.  Lead positions were confirmed with AP and lateral views.  Under direct AP visualization the lead was then advanced parallel and to the Left of the first lead at Left T7*......"

Thanks in advance!


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## Cassandra Stone (May 17, 2013)

Hi Joanne, you can bill for placement of 2 leads. I usually bill this procedure bilaterally based on how the insurance wants bilateral procedures submitted. (ie for Medicare they want 1 unit with modifier 50, and double the fee) Hope this helps


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## dwaldman (May 17, 2013)

My understanding is you would not use 50 modifier with 63650. I have found that it is based on the payer on how their system can process it.

For example, WPS Medicare I would have to bill as such:

63650
63650-51 modifier with additional note stating Placement of Second Array

For the Medicaid carrier we bill:

63650 x2

For certain carriers, you might need to report 63650 63650-59 in order their system to process and deny for a duplicate.

Below is an older CPT Assistant that suggested modifier 51

April 1999 page 10

AMA CPT Assistant Coding Consultation:Surgery Nervous System, 63650 (Q&A)

Surgery Nervous System, 63650 (Q&A) 

Question: My doctor performed a procedure in which percutaneous placement of two neurostimulator electrode catheters were placed through two separate sites. How should this procedure be reported? 

Answer: CPT makes no distinctions as to the number of sites required for the placement of electrode catheters. CPT code 63650, Percutaneous implantation of neurostimulator electrode array, is reported for the placement of the initial neurostimulator electrode catheter. Percutaneous placement of additional catheters is reported with CPT code 63650 appended by modifier '-51.'


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## joanne71178 (May 21, 2013)

Yes, this is very helpful. 

Thank you!


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