Neurosurgery Coding Alert

Question: Is this what I would use for this case? Patient has complex regional pain syndrome involving left lower extremity starting in the lower portion and spreading to the medial thigh region. He was offered a spinal cord stimulator with a trial of paddle lead placement. Our billing company says because this was a "trial", it is not billable to his insurance. We don't agree. Please advice and offer CPT® codes for this.

Ohio Subscriber

Answer: You report 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) if your surgeon does a laminectomy to implant the spinal cord stimulator. Spinal cord stimulation can be achieved by two procedures. The first one is the percutaneous method and the second one is an open surgical technique. Most providers prefer the percutaneous method for trials as it is less invasive. In fact, the percutaneous method is widely used for trials as well as permanent implants. The open surgical technique involves laminectomy through which a ribbon-type surgical or paddle lead is placed in an antegrade or retrograde fashion. The paddle or plate, when compared to the percutaneous lead, allows for broader coverage with a more stable lead. A number of clinical factors and your surgeon's preferences may necessitate the placement of a paddle.

Look at the term 'paddle lead placement' in the procedure that your surgeon is doing. It is a direct cue for you to head to code 63655. Remember, trial lead placement is coded the same as a permanent lead placement. The difference reflects the percutaneous approach compared with an open laminectomy approach.