Neurosurgery Coding Alert

Question: Our surgeon treated a patient with medically intractable epilepsy by replacing her pulse generator with a new one, using a new incision and pocket. Using stereotactic guidance, he created bilateral burr holes and implanted electrode arrays, then he performed a craniectomy and inserted an RNS pulse generator. After that, he reopened her prior VNS internal pulse generator (IPG) incision, removed her old IPG and left the old electrode behind.  

I-m planning to report 61863 and 61864 for the two electrode arrays, and 61886 for the RNS pulse generator, along with 61888 for the removal of the vagal stimulator. Is that accurate?

Tennessee Subscriber

Answer: According to CPT guidelines, you should not report 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver) in addition to 61886 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays) if the surgeon removes and reinserts the same pulse generator, since the removal is considered inclusive to the reinsertion (61886).

But because your surgeon replaced the old generator with a new one, and placed it in a separate pocket through a separate incision, you should report both 61886 and 61888-59 (Distinct procedural service).

Because the physician implanted two electrode arrays through separate burr holes, you are also justified in reporting both 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) and +61864 (... each additional array [list separately in addition to primary procedure]).