Neurosurgery Coding Alert

Question: Our physician removed two leads and a pulse generator due to the patient’s cellulitis over the pocket of the generator. When our physician excised the cellulitic area, the excision also involved excision of the internal pulse generator capsule in its entirety. What is the most appropriate code for the debridement of the pocket?

Virginia Subscriber

Answer: The best code for removal of the pulse generator is 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver). To be able to report the debridement, you will have to know that Correct Coding Initiative (CCI) edits bundle repair codes with CPT® code 63688. The debridement of the pocket would be considered part of the service in 63668 and most payers probably consider the debridement as part of the removal code 63688. 

However, depending upon what your physician exactly did, you may be justified in reporting both the debridement and removal/repair. You’ll need to study the documentation to verify whether this might be the case. Check if the debridement was a separate procedure such as that performed in a different anatomic area instead of a component of removing the pulse generator and preparing the pocket wound closure.