Anesthesia Coding Alert

Correctly coding and getting reimbursed for dual leads hinges on appropriate documentation up front, experts explain.

Patients with chronic, neuropathic pain may be treated with spinal cord stimulators to increase their comfort and quality of life. Pain management practices are treating increasing numbers of these patients.

Problems sometimes arise when the patient is treated for pain in the back or lower extremities, and more than one lead of electrodes is needed for the procedure. For example, the patient may need leads for both legs, or for one leg and another area, because a single lead isnt long enough to cover the necessary area.

A single lead or catheter has eight electrodes on it, says Brenda Lomenick, office manager of Specialists in Pain Management in Chattanooga, TN. Thats fine for most of our patients, but not for all of them. Were treating more and more patients who need multiple leads to cover the area for adequate pain relief, and some carriers dont recognize that fact.

As a result, these carriers deny reimbursement for one of the leads, saying that the physician is double charging for the service. Lomenick and Michelle Skogstrana, billing supervisor of Pain Consultants of the Rockies in Cheyenne, WY., say the denials occur because the current CPT code 63650 (percutaneous implantation of neurostimulator electrode array, epidural) is based on a collection of electrodes instead of the lead as a single unit.

We code the procedure as 63650 for each lead used, says Skogstrana, because thats the right code for it. Sometimes were reimbursed for everything, and sometimes were not. It depends partly on the carrier and even partly on the representative you speak to at the carriers office. You may get lucky and talk to someone who understands the situation and will send the claim through without any problems.

Skogstrana thinks part of the reason carriers are more attuned to charges for electrode leads is because some physicians and billing personnel have taken advantage of the situation in the past. If you interpret the CPT definition literally, it seems like the code is for a single electrode. Anyone who is familiar with coding knows you bill by the lead, not the electrode, and that the code is really for one string, or set, of electrodes. But some people were taking the definition literally and billing it eight timesone for each electrode. I think thats part of the reason why carriers are so leery of reimbursing for dual leads-they think youre trying to slip a double charge through the system.

Billing for Complete Reimbursement

Lomenick explains, The procedure must be dictated correctly and the notes must be clear that two separate leads are being used. The physicians dont [...]