Neurosurgery Coding Alert

A trio of code sets represents these surgeries.

Patients requiring open neurostimulator electrode array placement can suffer from a variety of ailments, from migraine to incontinence. It’s up to you to pair the proper diagnosis code with the proper CPT^® code on all your array claims.

Further, you need to make sure that the nerve area in which the surgeon places the array is accurately depicted in the coding, as CPT^® has codes for different nerve areas.

Check out this primer on open neurostimulator electrode array placement.

Know Who Needs Neurostimulator Arrays

You’ll need to be able to identify patients that might need neurostimulator electrode arrays. The devices are typically required for individuals with neurological impairments to the brain, spinal cord, or peripheral nerves. Once implanted, the devices work through neuromodulation — altering nerve activity with targeted bursts of electrical stimulation.

These devices are typically recommended when conventional treatments (like medication or physical therapy) are ineffective or insufficient.

Best bet: There’s going to have to be proof of less conservative treatments that failed before you can report an electrode array implant. The surgeon won’t decide on surgery unless other ways to deal with the injury are employed: medication, physical therapy, surgery etc. Make sure those nonsurgical attempts to treat the patient’s neurological injury are noted in the medical record.

These Patients Often Need Arrays

There are certain conditions that will lead themselves to open neurostimulator electrode array implants. While this is not an exhaustive or approved list of diagnoses, many patients who undergo this procedure suffer from one of the following injuries/ disorders:

• Complex regional pain syndrome (CRPS)
• Failed back surgery syndrome
• Neuropathic pain
• Parkinson’s disease
• Essential tremor
• Dystonia
• Epilepsy
• Chronic migraine
• Cluster headache
• Urinary/fecal incontinence

Note: This is not an approved list of conditions for which open neurostimulator electrode array implants are covered, merely a list of conditions that could prompt the procedure. Always check with your payer for a list of acceptable diagnoses for open electrode array implants.

Get Your Nerve Up Before Choosing Code

There are five nerve areas that your surgeon could connect to neurostimulator electrode arrays: cranial, peripheral, neuromuscular, sacral, and hypoglossal. You need to know the nerve area in order to choose the correct code.

Here’s a look at the open neurostimulator electrode array implantation codes:

• 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver)
• 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) through 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array)
• 64568 (Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator) through 64582 (Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array)

Example:

A patient with intractable focal idiopathic epilepsy with localized seizures and status epilepticus that hasn’t responded to more conservative treatments reports to the neurosurgeon. The surgeon makes an incision at the front of the neck to expose the left vagus nerve, which the surgeon then isolates. They then wrap an electrode array around the vagus nerve and connect it to a lead. Then, the surgeon makes an incision in the upper chest, creates a small pocket under the skin for the neurostimulator, tunnels the array from the neck to the chest, and connects it to the neurostimulator. They then close the neck and chest incisions with sutures.

For this encounter, you’d report 64568 for the electrode array placement with G40.011 (Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus) appended to represent the patient’s epilepsy.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC