Neurosurgery Coding Alert

Question: Our neurosurgeon implants a spinal neurostimulator. The neurosurgeon positions two electrode arrays in the epidural space for treatment of bilateral leg pain. How should I report this?

Georgia Subscriber

Answer: You should report two units of 63650 (Percutaneous implantation of neurostimulator electrode array, epidural). Be sure to include modifier 59 (Distinct procedural service) to the second unit of 63650 (and all subsequent units) to alert the payer that the physician placed the additional electrodes at different anatomical locations.

Keep in mind: Rather than an epidural electrode array, the neurosurgeon may instead insert a plate or paddle electrode, via laminectomy, to provide stimulation.

To describe such placement of a plate or paddle electrode, you would report 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural).

Before you file, check with your payer or Medicare carrier for a complete list of preconditions and allowable diagnoses for spinal cord stimulation coverage.

Tip: The national Correct Coding Initiative bundles fluoroscopic guidance into epidural electrode array placement. Therefore, you would not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction), when performed, in addition to 63650.