Neurosurgery Coding Alert

Hint: Make sure you count arrays and confirm recording in subcortical electrodes.

If you come across documentation where your neurosurgeon has inserted a cranial neurostimulator, you need to make sure you clearly understand all of the different details involved.

Neurostimulator defined: A neurostimulator pulse generator system is a surgically implanted, battery-powered device that delivers electrical stimulation to the brain, spinal cord, or peripheral area to treat certain neurological disorders.  

Editor’s note: Stay tuned next month to learn even more tips regarding neurostimulator reporting.

Check out the following handy tips to safeguard your neurostimulator claims.

Tip 1: First, Define These Terms for Neurostimulator Coding Clarity

When your surgeon inserts a neurostimulator, you should look to codes 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver).

Don’t miss: Codes 61850 through 61888 apply to both simple and complex neurostimulators, according to CPT^®.

As you look at the code descriptors of these neurostimulator codes, other important terms you should be familiar with to achieve reporting success include the following:

• Burr hole — a hole the neurosurgeon drills into the patient’s skull using a burr drill
• Craniectomy — a surgical procedure where the neurosurgeon permanently removes a piece of the skill or brain flap to access the inside of the patient’s cranium
• Craniotomy — a surgical procedure where the neurosurgeon removes a piece of the patient’s skull or brain flap used to access the inside of the cranium and then returns to the patient’s skull in its normal position prior to closure
• Twist drill — A handheld and manually-operated drill with one or more deep spiral grooves that extend from the point to the smooth part of the shaft.

Tip 2: Focus on Using Programming Codes Appropriately

Per CPT^® guidelines, for initial or subsequent electronic analysis and programming of neurostimulator pulse generators, you should report codes 95970 (Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming) through +95979 (… (eg, rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; each additional 30 minutes after first hour (List separately in addition to code for primary procedure)).

“The surgeon’s work is not necessarily completed after placement of the neurostimulator electrode and generator,” says Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “There is often intraoperative programming of the generator, which is reported with the applicable electronic analysis and intraoperative/initial programming codes.”

Tip 3: Identify Surgeon’s Approach for Cortical Electrodes

If you need to report cortical electrode placement, you must first know which approach the surgeon used.

Twist drill or burr hole: When your surgeon uses a twist drill or burr hole to implant the cortical neurostimulator electrodes, report 61850.

Craniotomy or craniectomy: If the neurosurgeon implants the cortical electrodes via a craniotomy or craniectomy, then you should report 61860 (Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical).

Tip 4: Count Arrays and Confirm Recording in Subcortical Electrodes

Without intraoperative recoding: When the surgeon implants the first array of subcortical electrodes but does not obtain an intraoperative recording, you should report 61863 (Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array). For each additional array, you should report code +61864 (……without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)).

With intraoperative recording: When your surgeon also does an intraoperative recording in addition to implanting the subcortical array of electrodes, you should report code 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) for the first array and +61868 (….. with use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)) for each additional array.

Don’t miss: Microelectrode recording, when the operating surgeon performs it in association with the implantation of neurostimulator electrode arrays, is an inclusive service and should not be reported separately, per CPT^® guidelines. “These codes are most commonly used to report placement of deep brain stimulator electrodes for treatment of Parkinson’s disease,” says Przybylski.

ICD-10 connection: If the neurosurgeon uses a deep brain stimulator (DBS) to treat Parkinson’s disease, make sure you know where to look in the ICD-10 manual to report the Parkinson’s diagnosis, which is found in category G20 (Parkinson’s disease).