nyyankees
True Blue
has anyone ever seen 63655 AND 63042 billed out together? Curious.
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Wiki 63655 + 63042
- Thread starter nyyankees
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I have never seen this but I guess it could be possible. Was the laminectomies performed on two different levels?
nyyankees
True Blue
he was not specific as to where he places the stimulators..
RebeccaWoodward*
True Blue
I agree with the previous poster. This is an unusual situation. It would be interesting to see the op note...if available.
nyyankees
True Blue
Op Report
We dissected down to the T8 to get through some of the scar tissue and see a more normal tissue. At this point we were able to get into the epidural space. The paddle was placed in the epidural space. In fact, it was always going to the left side which would not have helped this patient since he has bilateral leg symptoms as well as back pain. At this point, after repeated attempts to move the paddle and it did not move, a second incision was made. This incision was at T8 area, and a T8 laminectomy was done. He had a significant amount of ossification in this area, and in fact, his ligamentum flavum was ossified and was very difficult to get through after the laminectomy was done, and being through the ligamentum flavum to the epidural space, then the paddle was placed again. The paddle still went to the left side, but it was able to be manipulated and placed in the midline. It was secured in place. At this point, a pocket was made on the left side. A transverse incision was made and dissected back down, and it was created. Next, the anchors were placed, and the paddle electrodes were tunneled through the pocket. At this point, the battery was connected and impendence was chcked which was very good at all levels. Next the battery was programmed and placed underneath the skin.
Dr wants to bill 63655, 63685, 95972 and 63042. My question (with stimulators) is the paddle has some length to it. Can it cross multiple segments? Haven't had much experience billing spinal stimulators and I know they can be tricky. Thanks. I look forward to your opinions.
We dissected down to the T8 to get through some of the scar tissue and see a more normal tissue. At this point we were able to get into the epidural space. The paddle was placed in the epidural space. In fact, it was always going to the left side which would not have helped this patient since he has bilateral leg symptoms as well as back pain. At this point, after repeated attempts to move the paddle and it did not move, a second incision was made. This incision was at T8 area, and a T8 laminectomy was done. He had a significant amount of ossification in this area, and in fact, his ligamentum flavum was ossified and was very difficult to get through after the laminectomy was done, and being through the ligamentum flavum to the epidural space, then the paddle was placed again. The paddle still went to the left side, but it was able to be manipulated and placed in the midline. It was secured in place. At this point, a pocket was made on the left side. A transverse incision was made and dissected back down, and it was created. Next, the anchors were placed, and the paddle electrodes were tunneled through the pocket. At this point, the battery was connected and impendence was chcked which was very good at all levels. Next the battery was programmed and placed underneath the skin.
Dr wants to bill 63655, 63685, 95972 and 63042. My question (with stimulators) is the paddle has some length to it. Can it cross multiple segments? Haven't had much experience billing spinal stimulators and I know they can be tricky. Thanks. I look forward to your opinions.
RebeccaWoodward*
True Blue
I really don't see 63042. 63655 captures the lami in it's description of the code. It's possible to add modifier 22 for, what appears to be, added difficulty.
"He had a significant amount of ossification in this area, and in fact, his ligamentum flavum was ossified and was very difficult to get through after the laminectomy was done".....not to mention the 1st incision was unsuccessful. Of course, this is the physicians call.
Many times, the paddle/electrodes can span over additional segments; however, it's only when 2 paddles are placed at 2 separate levels, can you bill 63655 twice.
Anyone else?
"He had a significant amount of ossification in this area, and in fact, his ligamentum flavum was ossified and was very difficult to get through after the laminectomy was done".....not to mention the 1st incision was unsuccessful. Of course, this is the physicians call.
Many times, the paddle/electrodes can span over additional segments; however, it's only when 2 paddles are placed at 2 separate levels, can you bill 63655 twice.
Anyone else?
nyyankees
True Blue
Thanks