Neurosurgery Coding Alert

Consider programming part of implantation Implanting spinal neurostimulators involves several distinct steps, each of which offers a variety of coding opportunities. In part one of this two-part series, our experts lead you through the initial stage of the process so that you won't miss any of the reimbursement your surgeon deserves. Trial Implant Is a Must Candidates for spinal neurostimulation must undergo a trial to prove treatment efficacy. You will select from two codes to describe the surgeon's work during this period. "Neurostimulators are often a -last resort- for patients with chronic, intractable pain," explains Mark Telles, senior manager of therapy access at Medtronic Neuromodulation. "Only if the patient shows benefits during a trial -- a good outcome is defined as pain relief of 50 percent or better -- will the surgeon move forward with a long-term implant." Before you file: Check with your payer or Medicare carrier for a complete list of preconditions and allowable diagnoses for spinal cord stimulation coverage. The trial begins with placement of one or more catheter electrode arrays, or plate/paddle electrodes, at precise locations along the epidural space around the spinal cord. The electrodes allow for direct stimulation of the dorsal columns (posterior spinal cord) to mask the patient's pain. A catheter electrode consists of a wire "about the width of angel hair pasta," Telles explains. The physician threads the wire through a hollow needle inserted in the epidural space, using fluoroscopic guidance to ensure proper placement. The locus of the patient's pain determines the number and precise placement of electrode array(s). For this procedure, report one unit of 63650 (Percutaneous implantation of neuro-stimulator electrode array, epidural) for each electrode array that the surgeon inserts. Tip: The national Correct Coding Initiative bundles fluoroscopic guidance into epidural electrode array placement. Therefore, you would not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction), when performed, in addition to 63650. Example: If the surgeon positions two electrode arrays in the epidural space for treatment of bilateral leg pain, you would report two units of 63650. You should append modifier 59 (Distinct procedural service) to the second unit of 63650 (and all subsequent units) to alert the payer that the physician placed the additional electrodes at different anatomical locations. Rather than an epidural electrode array, the surgeon may instead insert a plate or paddle electrode, via laminectomy, to provide stimulation. To describe such placement of a plate or paddle electrode, you would report 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural). "This is a more involved, invasive procedure," Telles [...]