Neurosurgery Coding Alert

Check for cortical, subcortical, and cerebellar locations; count arrays.

You can downsize your neurostimulator reporting headaches and steer your claims to payment success if you know how to account for electrode arrays, neurostimulator pulse generators and receivers.

Confirm Approach for Cortical Electrodes

When reporting cortical electrode placement, you need to confirm what approach your surgeon adopted, specifically whether through a burr hole or an open craniectomy or craniotomy. When your surgeon uses a twist drill or burr hole for implanting cortical neurostimulator electrodes, you report code 61850 (Twist drill or burr hole[s] for implantation of neurostimulator electrodes, cortical). If the cortical electrodes are implanted using a craniotomy or craniectomy, you report code 61860 (Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical).

Count Arrays and Confirm Recording in Subcortical Electrodes

When your surgeon implants the first array of subcortical electrodes but does not obtain an intraoperative recording, you report code 61863 (Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site [e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray], without use of intraoperative microelectrode recording; first array). For each additional array, you report code +61864 (……without use of intraoperative microelectrode recording; each additional array [List separately in addition to primary procedure]).

When your surgeon also does an intraoperative recording in addition to implanting the subcortical array of electrodes, you report code 61867 (……. with use of intraoperative microelectrode recording; first array) for the first array and +61868 (….. with use of intraoperative microelectrode recording; each additional array [List separately in addition to primary procedure]) for each additional array.

Microelectrode recording, when performed by the operating surgeon in association with implantation of neurostimulator electrode arrays, is an inclusive service and should not be reported separately. “These codes are most commonly used to report placement of deep brain stimulator electrodes for treatment of Parkinson’s disease,” Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Identify Discrete Codes for Cerebellar Electrodes

When reporting cerebellar neurostimulator electrodes, you have specific codes for the cortical and subcortical electrodes. These are 61870 (Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical) and 61875 (Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical).

Distinguish Pulse Devices from Arrays

If  your surgeon inserts or replaces a neurostimulator pulse generator or receiver, you report code 61885 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) or 61886 (….. with connection to 2 or more electrode arrays) depending upon whether the device was connected to one or more electrode arrays.  “If performed in the same operative setting, the generator code would be reported in addition to the neurostimulator code(s).  If performed at a later date within the global period of the neurostimulator implant, a 58 modifier for stage surgery would be applied to the generator code,” says Przybylski.

Check Components for Revision or Removal

For the revision or removal services, you need to identify whether your surgeon revised/removed the electrodes or the pulse generator device. You may either report code 61880 (Revision or removal of intracranial neurostimulator electrodes) or 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver) depending upon what component your surgeon is revising/removing.

Code 61880 includes repositioning of the electrode to enhance patient response. If the revision/removal occurs during the global period of the initial surgery, append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to the appropriate code.

Remember: You do not report 61888 in conjunction with 61885 or 61886 for the same pulse generator.

Example: You may read that your neurosurgeon replaced an old VNS generator with a new generator. This could leave you perplexed about whether you can report 61885–61886 alone, or whether to report 61885–61886 along with 61888. Codes 61885 and 61886 are for insertion or replacement of a neurostimulator. Look at the number of electrode arrays your neurosurgeon connects to the generator. You report 61885 if your neurosurgeon places a neurostimulator pulse generator or receiver that’s attached to a single electrode array. You report 61886 for generator placement when it is attached to multiple electrode arrays.

Bottom line: You should only bill one code for the removal and/or replacement when it is performed through the same incision. Do not report 61888 in conjunction with 61885 or 61886 for the same pulse generator. Thus, you report 61885 when your surgeon replaces the generator through the same incision. When your neurosurgeon only performs a removal or revision, you report 61888.

Caveat: You may report both 61886 and 61888 and append modifier 59 (Distinct procedural service) when your surgeon replaces the pulse generator by making a new incision.

Example: You may read that in a patient with medically intractable epilepsy, your surgeon replaced the pulse generator with a new one, using a new incision and pocket. You may further read that ‘Using stereotactic guidance, bilateral burr holes were created and electrode arrays were implanted. A craniectomy was done and an RNS pulse generator was inserted. Then the prior VNS internal pulse generator (IPG) incision was reopened and the old IPG was removed and the old electrode was left behind.”

What to code: In this scenario, your surgeon replaced the old generator with a new one, and placed it in a separate pocket through a separate incision. So you should report both 61886 and 61888-59. Your surgeon implanted two electrode arrays through separate burr holes, so you report 61863 and +61864.

Note: Codes 61850-61888 apply to both simple and complex neurostimulators. For initial or subsequent electronic analysis and programming of neurostimulator pulse generators, you report codes 95970-95975.