Part B Insider (Multispecialty) Coding Alert

Sometimes the neurostimulator electrodes move from the area that needs to be stimulated and need to be realigned. Or the patient may decide he or she wants the electrodes removed if they're too uncomfortable, stop working properly or become infected.
 
In 1999, HealthNow NY and a number of other Part B carriers instituted local medical review policies covering revision or removal of spinal neurostimulator leads. Use 63660 (Revision or removal of spinal neurostimulator electrode) or CPT 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver) to bill for this service.
 
HealthNow and the other carriers said they'd cover revision or removal if the physician had implanted the leads in accordance with Medicare guidelines. Also, the physician should have implanted the stimulator as a late resort (or last resort) for patients with chronic intractable pain, after trying some other methods and screening by a multidisciplinary team. Also, the patient should have undergone a test of pain relief through a temporarily implanted electrode.
 
If the removal comes as a result of infected leads, the physician must send the leads to an independent lab for cultures, and the cultures must be part of the medical record.