Wiki SCS Lead Placement L8680

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abyars82

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I am aware of MCR final rule that this code is no longer applicable with procedure code 63650 for MCR patients... BUT what about other payers? Biggest question being if 32 leads were attempted but only 16 were actually placed successfully, can you bill for all 32 leads and what would that look like...? :confused:
 
It sounds like two leads with 16 electrode contacts on each lead.

63650 with quantity 2 if the documentation supports two separate electrode arrays (leads) are placed. Again this is two separate leads/arrays are placed.

I would contact the manufacturer's rep and discuss the type of leads that were used and how many electrode contacts were on the leads. If you have the invoice you might be also crosswalk the lead used to get more specifics.

I would also ask the rep to speak to the regional reimbursement manager from their company and discuss what other practices in your area are doing to process other payers.
 
If you are able to bill the HCPCS code you mention then you can report the electrode contacts on those leads such if the lead has 8 electrode contacts than you could bill quantity of 8 for the L8680.
 
Thank you for your help.
From reading the CPT book carefully and MCR final rule about adjusting the RVU's on 63650 to include the value of the leads... the MD and I believe any insurance company would deny the two codes together on grounds for bundling. After speaking with the DR further about this particular procedure- the reason for 32 leads being that the first attempt at 16 on the RT side was unsuccessful.... hence 16 new leads placed on the left. Either way- I believe L8680 is not separately billable with 63650 in an office setting any longer.
 
What I ended up doing was billing
63650, LT
63650,53RT
and included supporting documentation.
I'm watching to see how MCR handles this....
 
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