Neurosurgery Coding Alert

Question: In a patient with bilateral leg pain, our surgeon placed two electrode arrays in the epidural space for trial neurostimulation and the patient returned a week later with positive results. Our surgeon disconnected the external neurostimulator and removed the trial electrode at the second visit. Finally, our surgeon called the patient for placement of a new electrode array and implantation of the long-term generator. Can we append modifiers 58 and 59 when submitting this claim?

New Mexico Subscriber

Answer: You submit code 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for the trial electrode placement. For disconnection of the external neurostimulator and removal of the trial electrode at the second visit, you report code 63661 (Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed). Your surgeon saw the patient again for placement of a new electrode array and implantation of the long-term generator. In this case, you would code 63650 for the new electrode array placement and 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) for the new pulse generator implanted. 

Tip: If instead of electrode arrays, the neurosurgeon does a laminectomy and implants plate or paddle electrode(s) for stimulation, you report 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) instead of 63650.

Modifiers: You append modifier 59 (Distinct procedural service) to the second (and each succeeding) unit of 63650 or 63655 to imply that the surgeon placed the additional electrode arrays at different anatomical sites. Additionally, you would append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period…..) to 63650/63655 and 63685 in the situation described above to identify that the services rendered at the final visit were anticipated and planned by the surgeon. You can use modifier 58 if you are doing electrode placement one day and connecting the generator later.