Neurology & Pain Management Coding Alert

Question:

Connecticut Subscriber

You have two code choices for the stimulator lead insertion, depending on the anatomic location of the trial placement: 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for the dorsal column / spinal cord stimulation and 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) for peripheral nerve stimulation.

Typically each lead/array/catheter used in spinal cord or peripheral nerve stimulation has multiple electrode contacts. However, billing is based on one unit of service for each lead/array/catheter inserted, not each electrode contact. For example, if your physician percutaneously inserted two trial epidural octrode leads (8 contact electrodes each), you would code 63650 and 63650-51 for the insertion. Even though the code description for peripheral nerve stimulator placement includes the term "electrodes," reporting is the same as spinal cord stimulator lead insertion per each single electrode array/lead.

DME watch: If your provider purchased the actual stimulator leads for the trial implantation in your office, you should also bill for the implants. The HCPCS code for the electrode array/leads fall under L8680 (Implantable neurostimulator electrode, each). Note that the descriptor specifies "electrode, each," so you base coding on the total number of electrode contacts rather than the number of leads/arrays. In the above example of trial insertion of two octrode leads, the provider would submit L8680 with 16 units of service for the actual implants. Some payers classify the implants as DME, which might require additional authorization before payment.