Neurosurgery Coding Alert

Pay attention to frequency of programming services If a surgeon moves forward with permanent placement of spinal neurostimulators, you will find yourself accessing many of the same codes you called upon to report the trial placement -- with a few wrinkles and additions. Read on for the rest of the story on error-free coding for spinal neurostimulators. Heed Trial Placement Last issue, we learned that most candidates for spinal neurostimulation must undergo a trial to prove treatment efficacy, and that you would report the trial placement of the stimulating electrodes using either 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) or 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural), as appropriate. In addition, you may report the surgeon's effort for programming the temporary, external generator used to power and control the implanted catheter array or plate/paddle electrode(s), most often using 95972 (Electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance, and patient compliance measurements]; complex spinal cord, or peripheral [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour). Permanent Placement Follows Trial After a successful trial, you would report the surgeon's implanting of a long-term pulse generator for continued treatment. This may involve up to three steps, explains Mark Telles, senior manager of therapy access at Medtronic Neuromodulation. 1. First, the surgeon may disconnect the temporary pulse generator and remove the previously placed electrode(s), for which you should report 63660 (Revision or removal of spinal neurostimulator electrode percutaneous array[s] or plate/paddle[s]). Claim this code only once, regardless of the number of catheter arrays or plates/paddles the surgeon removes. In addition, you should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to show that the surgeon anticipated the procedure. 2. After a period of healing following removal of the previously placed electrodes, the surgeon will place a new catheter array(s) or plate(s)/paddle(s), as required. You will report these services using 63650 or 63655, as described previously ("One-Step-at-a-Time Ensures Successful Spinal Stimulation Claims," Neurosurgery Coding Alert, Vol. 9, No. 9, pages 65-67). Once again, you should append modifier 58 to denote a staged service that occurs during the global period of an earlier procedure. 3. Finally, the surgeon will implant the long-term pulse generator, for which you would report 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) with modifier 58. "The implant occurs via a separate incision, usually either in the belly or the buttocks just below the waistline," Telles explains. "The surgeon then connects the leads to the generator by tunneling the wires [...]