Neurosurgery Coding Alert

The approach should be reported using either 61850, 61860 or 61862, depending on method. According to CPT Assistant, November 1999, 61860 describes implantation of neurostimulator electrodes in a cortical site by craniectomy or craniotomy, while 61862 describes stereotactically placed subcortical deep brain stimulation insertion by twist drill, burr hole, craniotomy, or craniectomy technique. The latter includes placement of a stereotactic frame, with determination of placement and/or alignment by CT or MRI scanning. Code 61850 describes insertion by twist drill or burr hole without stereotactic guidance.

Use 61885 or 61886 to describe the actual placement of the neurostimulator(s). Each involves "internalization of the tail of the electrode array and placement and connection of a subcutaneous neurostimulator generator for long-term brain stimulation," according to CPT Assistant. Code 61886 "differs in that the same insertion procedure is repeated for the electrode array on the other side, including tunneling of the tail of this electrode to the second limb of the bifurcated extension wire."

The local medical review policy (LMRP) published by Cigna Healthcare, the Medicare Part B carrier for North Carolina, specifies that a diagnosis of 332.0 (Paralysis agitans [idiopathic Parkinson's disease]) or 333.1 (Essential and other specified forms of tremor) must accompany the claim. Other Medicare carriers follow similar or identical guidelines.

The neurostimulator insertion codes do not include evaluation, testing, programming or reprogramming. Report these separately, using codes from the 95970-95975 series, as appropriate.

Note: Codes for subsequent removal or revision of the DBS unit include 61880(Revision or removal of intracranial neurostimulator electrodes) and 61888 ( of cranial neurostimulator pulse generator or receiver). Code 61880 would include repositioning of the electrode to enhance function or to respond to a progression of the disease.