Neurosurgery Coding Alert

You select amongst percutaneously placed versus laminectomy placed electrodes.

When reporting a spinal electrode replacement, you may find it easy to select the right code. You face a challenge when reporting the percutaneous and laminectomy approaches together. CCI 17.3 edits preclude the use of the two together. You carefully append the appropriate modifiers that may help you to overcome the edit.

CCI version 17.3, which took effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC.

As was the case with the previous CCI edition, the majority of edits impact the codes from the musculoskeletal code range (20000-29999), but bundles did occur to codes throughout the CPT® manual.

You can never miss an opportunity to earn for spinal neurostimulator electrode replacements if you know how to select and report the right code. There are the following two codes you need to choose from:

• 63663 (Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array[s], including fluoroscopy, when performed)
• 63664 (Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle[s] placed via laminotomy or laminectomy, including fluoroscopy, when performed)

The code descriptors veritably describe the approach used for the revision of the electrode array(s). Both these codes are inclusive of fluoroscopy. You report 63663 when your surgeon does the replacement/revision through the percutaneous route and 63664 when the same is done through a laminotomy or laminectomy. You report 63663 per 'array' or 'lead' placed. You report the same code multiple times if your surgeon revises more than one array. Hence, you actually count the number of arrays and not the number of electrode contacts on each catheter, plate, or paddle array placed. When your surgeon places or revises more than one arrays in the same anatomic site, you append modifier -59 (Distinct procedural service:...) to 63663.

Example: If you read that the surgeon made a midline incision, and performed a subperiosteal muscle dissection to reach the lamina where he performed a laminectomy to replace a single electrode array, you confirm this as an open procedure and report 63664.

CCI 17.3 edits describe 63663 and 63664 as 'mutually exclusive codes' and preclude the use of the two together under most circumstances.

You may override the CCI edit and report the two codes with modifier -59 (Distinct procedural service:...) when your surgeon revises arrays in different sites and adopts different approaches in the two anatomic sites.

"This is applicable in a situation where a patient with a cervical spinal cord stimulator placed by laminectomy and a thoracic spinal cord stimulator percutaneously loses coverage at both sites. The thoracic lead was broken, but the cervical lead was functional but had lost ideal position. A surgeon revises the cervical site by re-exploring the laminectomy site and adjusting the lead position, while the percutaneous thoracic lead is removed and replaced with another percutaneously placed lead," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Watch the global period: Code 63663 has a 10-day global period whereas 63664 has a 90-day global period as the latter involves laminectomy or laminotomy and paddle placement.

Editor's note: For more on CCI edits, visit the CMS Web site at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.