I am having to review this claim done by one of my new coders. However, this is not my specialty and I'm needing some clarification on the codes used and the ones I see.
The codes summited were :
63688
63663
63663,59
Insurance is Texas Medicare
I see
63685
63650
63650,51
here is the report
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Lumbar Radiculopathy
POSTOPERATIVE DIAGNOSIS: Same
OPERATION: Spinal Cord Stimulator Explantation, Epidural Spinal Cord Stimulation Percutaneous Lead Placement With Implantation Of Pulse Generator
TYPE OF ANESTHESIA: General
PROCEDURE: The patient was placed in the prone position on the procedure table. The lower back was sterilized and draped in standard fashion. After identifying the previously implanted IPG and leads, skin incision was made with a 10-blade scalpel and the IPG was freed from surrounding tissue by blunt dissection. The leads were disconnected from the IPG.
Attention was then turned to the midline spine. Skin incision was made with a 10-blade scalpel through the previous midline scar and the lead anchors were identified and freed from the surrounding tissue using blunt dissection. At this point the leads were pulled through the subcutaneous tunnel and an angiocath was utilized to access the epidural space using the seldinger technique on each side. The leads were then removed and the tips were noted to be intact.
Fluoroscopy was again utilized to pass the new lead through the angiocath under direct visualization and was positioned slightly ipsilaterally to the side of the midline and advanced to the superior endplate of T8.
The same procedure was repeated on the opposite side. The lead was advanced under direct visualization and positioned slightly ipsilaterally to the side of the midline and advanced to the superior endplate of T9.
At this point, the angiocaths were removed and the lead anchors were positioned and secured to the fascial layer using nonabsorbable suture.
Attention was then turned to the posterior flank. A 10 blade scalpel and blunt dissection was used to create a new IPG pocket due to uncomfortable location of previous IPG pocket. A tunneling device was utilized from the spinal incision area to the new pocket. The leads were then tunneled from the spinal incision area to the IPG pocket via the tunneling device and connected to the new IPG. Impedance testing was performed on both leads. The x-ray of the final position of the lead tips were saved to the PACS system.
After copious irrigation of each incision with antibiotic containing solution, the IPG was inserted into the pocket. The incisions were closed in layer by layer fashion and occlusive dressing was applied.
The patient tolerated the procedure well and was brought to the PACU in stable condition. Patient will be followed up as an outpatient by phone and office visit. Patient was advised against driving. Patient will schedule a follow-up in about one week and contact the office immediately if there is any swelling, redness, fever, weakness, numbness or discharge.
If anyone could help and explain the reasoning
thanks
The codes summited were :
63688
63663
63663,59
Insurance is Texas Medicare
I see
63685
63650
63650,51
here is the report
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Lumbar Radiculopathy
POSTOPERATIVE DIAGNOSIS: Same
OPERATION: Spinal Cord Stimulator Explantation, Epidural Spinal Cord Stimulation Percutaneous Lead Placement With Implantation Of Pulse Generator
TYPE OF ANESTHESIA: General
PROCEDURE: The patient was placed in the prone position on the procedure table. The lower back was sterilized and draped in standard fashion. After identifying the previously implanted IPG and leads, skin incision was made with a 10-blade scalpel and the IPG was freed from surrounding tissue by blunt dissection. The leads were disconnected from the IPG.
Attention was then turned to the midline spine. Skin incision was made with a 10-blade scalpel through the previous midline scar and the lead anchors were identified and freed from the surrounding tissue using blunt dissection. At this point the leads were pulled through the subcutaneous tunnel and an angiocath was utilized to access the epidural space using the seldinger technique on each side. The leads were then removed and the tips were noted to be intact.
Fluoroscopy was again utilized to pass the new lead through the angiocath under direct visualization and was positioned slightly ipsilaterally to the side of the midline and advanced to the superior endplate of T8.
The same procedure was repeated on the opposite side. The lead was advanced under direct visualization and positioned slightly ipsilaterally to the side of the midline and advanced to the superior endplate of T9.
At this point, the angiocaths were removed and the lead anchors were positioned and secured to the fascial layer using nonabsorbable suture.
Attention was then turned to the posterior flank. A 10 blade scalpel and blunt dissection was used to create a new IPG pocket due to uncomfortable location of previous IPG pocket. A tunneling device was utilized from the spinal incision area to the new pocket. The leads were then tunneled from the spinal incision area to the IPG pocket via the tunneling device and connected to the new IPG. Impedance testing was performed on both leads. The x-ray of the final position of the lead tips were saved to the PACS system.
After copious irrigation of each incision with antibiotic containing solution, the IPG was inserted into the pocket. The incisions were closed in layer by layer fashion and occlusive dressing was applied.
The patient tolerated the procedure well and was brought to the PACU in stable condition. Patient will be followed up as an outpatient by phone and office visit. Patient was advised against driving. Patient will schedule a follow-up in about one week and contact the office immediately if there is any swelling, redness, fever, weakness, numbness or discharge.
If anyone could help and explain the reasoning
thanks