ED Coding and Reimbursement Alert

Question: A physician at a pain clinic implanted a spinal cord neurostimulator in a patient, and five days later the patient presented to the ED complaining that the device kept misfiring. The ED physician spoke with the surgeon who implanted it, and the surgeon suggested gentle traction of the stimulator wire without total removal. The ED doctor removed about 10 cm of wire. How should I report this?


Delaware Subscriber

Answer: You should bill the appropriate E/M code based on the documentation (99281-99285).

CPT does have codes that describe similar procedures--such as 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver) and 63660 (Revision or removal of spinal neurostimulator electrode percutaneous array[s] or plate/paddle[s])--but the work and corresponding relative value units assigned to these codes far exceed the work the physician actually performed in this scenario, so you should skip these codes for this case.