Neurology & Pain Management Coding Alert

Question: In a patient with bilateral leg pain, our surgeon placed two electrode arrays in the epidural space for trial neurostimulation and the patient returned a week later with positive results. Our surgeon disconnected the external neurostimulator and removed the trial electrode at the second visit. Finally, our surgeon called the patient for placement of a new electrode array and implantation of the long-term generator. Can we append modifiers 58 and 59 when submitting this claim?

New Mexico Subscriber

Answer: You submit code 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for the trial electrode placement. The removal of the trial leads is not separately billable. Your surgeon saw the patient again for placement of a new electrode array and implantation of the long-term generator. In this case, you would code 63650 for the new electrode array placement and 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) for the new pulse generator implanted.

Tip: If instead of electrode arrays, the neurosurgeon does a laminectomy and implants plate or paddle electrode(s) for stimulation, you report 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) instead of 63650.

Modifiers: Your physician places the permanent leads and generator during the same surgery. If the permanent placement occurs within the 10-day global period of the trial (63650), you’ll need to append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period…..) to both codes: 63650 or 63655 for the permanent placement as well as 63685.