Neurosurgery Coding Alert

Question: In a patient with medically intractable epilepsy, the neurosurgeon replaced the pulse generator with a new one, using a new incision and pocket. According to the op note, the surgeon “used stereotactic guidance, created bilateral burr holes, and implanted electrode arrays.” He also performed a craniectomy and inserted an RNS pulse generator. He reopened the prior VNS internal pulse generator (IPG) incision and removed the old IPG and left the old electrode behind. Which CPT^® codes should we report?

Alabama Subscriber

Answer: Since the surgeon replaced the old generator with a new one and placed it in a separate pocket through a separate incision, you should report both 61886 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays) and 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver). You would append modifier 59 (Distinct procedural service) to the 61888 service. The surgeon implanted two electrode arrays through separate burr holes, so you will report 61863 (Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array) and +61864 (……without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)).

Don’t miss: When the surgeon implants the first array of subcortical electrodes but does not obtain an intraoperative recording, you should report 61863. And, for each additional array, you should report +61864.

Caution: Keep in mind that treatment of medically-intractable epilepsy with deep brain stimulation may not be a covered service by insurers because of limited information on safety and efficacy for this indication.