Neurosurgery Coding Alert

This is typically a 2-code service … or possibly more.

Patients that report to your neurosurgeon for placement of cranial neurostimulators give you the chance to report multiple codes for the service.

Why? Cranial neurostimulator placement includes two services that you’ll have to code correctly. There might also be opportunities to include an add-on code to these claims—if you know where to look.

Read on for advice on best practice for reporting these neurostimulator placement coding.

Report This for Drill/Burr Hole Procedure

The first portion of the placement service is creating the hole for the placement of the neurostimulator. The surgeon could create the hole via twist drill, burr hole, craniotomy, or craniectomy. No matter the method, you’ll report this service with 61867 (Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array).

During this portion of the service, the provider removes a portion of the skull or he may create burr holes in the skull. They then uses the stereotactic method, which makes use of a three-dimensional coordinate system to locate small targets inside the brain, and places a neurostimulator electrode array in the targeted location. More accurate targeting is achieved with the use of intraoperative microelectrode recording, according to Codify by AAPC.

Also, if the surgeon decides to place more than one array, report +61868 (… each additional array (List separately in addition to primary procedure) for each additional array. “After the placement of a first neurostimulator electrode array, the provider places an additional electrode array on the same site, or he may place the electrode array on a different site,” explains Codify by AAPC.

The surgeon identifies the additional targeted area of the brain “using the stereotactic method in which previously taken CT [computed tomography] or MRI [magnetic resonance imaging] images are imported into a computer system that provides three dimensional images of the brain,” reports Codify. During +61868 service, your surgeon might use the same opening as the first array, or they could create another opening.

Remember: You can only use the +61868 code as an add-on to another code; and the only code you can report +61868 with is 61867.

Choose From This Code Pair for Neurostimulator Placement

Once the surgeon has created the hole, they’ll next move onto neurostimulator placement. Depending on the number of connections to electrode arrays, you’ll choose between 61885 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) and 61886 (… with connection to 2 or more electrode arrays).

The difference: Both 61885 and 61886 are used to describe the surgeon making an incision and implanting or replacing “a direct or inductive cranial pulse generator or receiver in a subcutaneous pocket for connection to the electrode array(s),” per Codify. The only difference is that 61886 is for more than one array, meaning you’ll likely use 61886 on claims that include multiple arrays (61867 and +61868).

Here’s the Dx Codes Likely to Accompany Neurostimulator Implants

There are several different conditions your provider might treat with cranial neurostimulator implants. You should always check with your individual payer for diagnoses that are covered for 61867, +61868, 61885, and 61886. Surgeons perform many of these implants for patients with the following conditions:

• Parkinson’s disease: G20 (Parkinson’s disease)
• Essential tremors: G25.- (Other extrapyramidal and movement disorders), R25.- (Abnormal involuntary movements)
• Dystonia: G24.9 (Dystonia, unspecified)

Also: Some payers will require prior authorization for patients that are candidates for cranial neurostimulator implants. So, as always, keep abreast of your individual payer policies on diagnoses that are covered for this service and whether or not you need prior authorization.

Check out This Example

Here’s an example of a complete cranial neurostimulator placement encounter, from Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey:

A 55 year-old man with Parkinson’s disease has progressive primarily unilateral motor fluctuations and dyskinesias despite Sinemet, which was previously more effective. His disability is progressive and has persisted after medication adjustments. He has no signs of dementia, and is therefore considered a good candidate for deep brain stimulation targeting the subthalamic nucleus.

Using frameless image-guided stereotactic navigation, a cranial neuroelectrode array is placed through a burr hole. Intraoperative microelectrode recording is performed by a neurologist in order to optimize the final electrode placement. Through a separate subclavicular exposure, a subcutaneous pocket is created for placement of a generator. A subcutaneous tunnel is developed between the burr hole site and the subclavicular pocket to thread an extension lead to connect the single electrode array to the neurostimulator generator.

Coding: For this claim, you’d report:

• 61867 for the burr hole creation.
• 61885 for the single cranial electrode array placement with microelectrode recording and connection to a newly placed generator.
• Modifier 51 (Multiple Procedures) appended to 61885 to indicate multiple procedures, if your payer requires it.
• G20 (Parkinson’s disease) appended to 61867 and 61885 to represent the patient’s condition.