Neurosurgery Coding Alert

Question: My neurosurgeon replaced a vagus nerve stimulator (VNS) pulse generator with a new generator for a patient with medically intractable epilepsy. My neurosurgeon used a new incision and pocket. According to his medical documentation, he used stereotactic guidance, created bilateral burr holes, and implanted two electrode arrays. My neurosurgeon 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. Should I report 61886 or 61888 on my claim? I can’t decide which one is appropriate.

Maine Subscriber

Answer: In this case, your neurosurgeon was discontinuing use of a cranial nerve (vagus) neurostimulator with removal of the pulse generator, leaving the electrode in place. At this, is considered a peripheral site, you should report 64595 (Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver) for the removal of this generator. To manage the medically intractable epilepsy, the neurosurgeon instead placed a cranial pair of electrode arrays and inserted a cranial pulse generator that could accommodate more than one array. You should report 61886 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays) for the generator insertion.

Don’t miss: As the other removed generator is not a cranial generator, you should not report 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver). CPT^® rules preclude reporting both 61886 and 61888 for the same pulse generator.

Also, do not forget to report the applicable codes for placement of the intracranial neurostimulator arrays, codes 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through +61868 (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), with use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)).

Caution: When the surgeon implants the first array of subcortical electrodes but does not obtain an intraoperative recording, you should report 61863. For each additional array, you should report +61864.