Neurosurgery Coding Alert

Hint: Don’t report 61888 in conjunction with 61885 or 61886 for same pulse generator.

You learned handy tips on reporting neurostimulators in the article “Handy Tips Streamline Your Cranial Neurostimulator Reporting, found in Neurosurgery Coding Alert Vol. 19, No. 6. Read on to elevate your neurostimulator knowledge even further and to protect your reimbursement.

Delve Into These “Connection to Electrode Array” Options

If the surgeon inserts or replaces a neurostimulator pulse generator or receiver, report 61885 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) or 61886 (… with connection to 2 or more electrode arrays) depending upon whether the device was connected to one or more electrode arrays.   

“If performed in the same operative setting, the generator code would be reported in addition to the neurostimulator code(s),” says Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “If performed at a later date within the global period of the neurostimulator implant, a 58 modifier for staged surgery would be applied to the generator code.”

Understand Complete Details of the Revision or Removal

For the revision or removal services, you must identify whether the surgeon revised or removed the electrodes or the pulse generator device. You may either report code 61880 (Revision or removal of intracranial neurostimulator electrodes) or 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver) depending upon what component your surgeon is revising or removing.

61880: Code 61880 includes repositioning of the electrode to enhance patient response. You should append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to 61880 if the revision or removal occurs during the global period of the patient’s initial surgery.

Caution:  Modifier 78 applies to an “unplanned” related surgical procedure by the same physician during the post op period, according to Catherine A. Brink, BS, CMM, CPC, CMSCS, president of HealthCare Resource Management Inc. in Spring Lake, New Jersey.

Use modifier 78 “when the patient returns to the OR (operating room) during the global period of another related procedure for a complication or other unanticipated problem” related to the initial surgery, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

61888: You should never report 61888 in conjunction with 61885 or 61886 for the same pulse generator, according to a note in CPT^®.

Coding scenario: In the op note, the surgeon wrote that he replaced an old VNS generator with a new generator. To know whether you should just report 61885 or 61886 or whether you can report those codes along with 61888, look at the number of electrode arrays your neurosurgeon connects to the generator. Report 61885 if the neurosurgeon places a neurostimulator pulse generator or receiver that’s attached to a single electrode array. And, report 61886 for generator placement when it is attached to multiple electrode arrays.

Bottom line: Only bill one code for the removal and/or replacement when it is performed through the same incision. Never report 61888 in conjunction with 61885 or 61886 for the same pulse generator. You report 61885 when the surgeon replaces the generator through the same incision. When the neurosurgeon only performs a removal or revision, you report 61888.

Can Report Both 61886 and 61888 With Modifier 59 in This Instance

You may report both 61886 and 61888 and append modifier 59 (Distinct procedural service) when the surgeon replaces the pulse generator by making a new incision.

Coding scenario: In a patient with medically intractable epilepsy, the surgeon replaced the pulse generator with a new one, using a new incision and pocket. According to the op note, the surgeon “used stereotactic guidance, created bilateral burr holes, and implanted electrode arrays.” He also performed a craniectomy and inserted an RNS pulse generator. He reopened the prior VNS internal pulse generator (IPG) incision and removed the old IPG and left the old electrode behind.

Since the surgeon replaced the old generator with a new one and placed it in a separate pocket through a separate incision, you should report both 61886 and 61888-59. The surgeon implanted two electrode arrays through separate burr holes, so you will report 61863 (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), without use of intraoperative microelectrode recording; first array) and +61864 (……without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)).

Don’t miss: When the surgeon implants the first array of subcortical electrodes but does not obtain an intraoperative recording, you should report 61863. And, for each additional array, you should report +61864.