Neurosurgery Coding Alert

Question: The physician replaced two sets of spinal cord stimulator leads with eight contacts each. He suggested we bill the code twice, but I think you can only report 63663 once with one unit because the descriptor states "array(s)." What's the correct coding approach?

Wyoming Subscriber

Answer: You report 63663 (Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array[s], including fluoroscopy, when performed) per "array" or "lead," so you can submit 63663 multiple times if your physician revises more than one array. Notice that the descriptor includes revision and replacement of new arrays, so you don't need to also report 63650 (Percutaneous implantation of neurostimulator electrode array, epidural). The relative value unit (RVU) calculation allows for the additional service associated with 63663 (total facility RVU 12.79 for 63663 versus 10.91 total facility RVU for 63650).

If he places or revises the arrays in the same anatomic site, append modifier 51 (Multiple procedures) to 63663. If he revises arrays in different anatomic sites, append modifier 59 (Distinct procedural service) instead.

Remember: Calculate your code selection based on the number of arrays, not the number of electrode contacts on each catheter, plate, or paddle array placed.