Neurosurgery Coding Alert

Remember: Never report 95971 in conjunction with 95972.

If your neurosurgeon performs a service involving a spinal neurostimulator in your practice, you will need to check the medical documentation for numerous details including whether your surgeon implanted, removed, or revised the neurostimulator. You must also pay special attention to which codes you cannot report together on your neurostimulator claims.

Read on to learn more.

Tip 1: Rely on These 2 Codes for Implantation of Spinal Neurostimulator

If your neurosurgeon implants a spinal neurostimulator, you should turn to the following two codes:

• 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) Note: Your neurosurgeon will percutaneously place the neurostimulator system during a 63650 service, so the contacts are on a catheter-like lead. “An array defines the collection of contacts that are on one catheter,” according to the CPT^® guidelines.
• 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural)

Don’t miss: During a 63655 procedure, your neurosurgeon will remove the lamina and place a permanent plate/paddle electrode in the epidural space or the area between the dura membrane and the wall of the vertebra for spinal cord stimulation. When your neurosurgeon places the spinal neurostimulator via open surgery, the contacts will either be on a plate or a paddle-shaped surface, per CPT^®.

“It is important to note that while a trial electrode (used to determine whether the technology provides a patient with satisfactory pain relief) is typically done percutaneously, the permanent electrode (intended to remain long-term after a successful trial) could be placed either percutaneously or through an open procedure that includes a laminectomy,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “Therefore, the placement method (percutaneous or open with laminectomy) is important to determine rather than whether the procedure is for a trial or permanent implant.”

Tip 2: Surgeon Removed Spinal Neurostimulator? Do This

When your neurosurgeon removes spinal neurostimulator electrodes, he can perform the approach in one of the following two ways:

• 63661 (Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed). Note: You should never report 63661 when your neurosurgeon removes or places “a temporary percutaneously placed array for an external generator,” according to CPT^®.
• 63662 (Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed)

Don’t miss: The contacts in a 63661 neurostimulator implant are on a catheter-like lead, just like with code 63650. On the other hand, with a 63662 neurostimulator implant, the contacts are located on a plate or paddle-shaped surface placed during an open surgical procedure, just like with code 63655.

Coding tip: As you can see from the code descriptors, 63661 and 63662 include fluoroscopy when your neurosurgeon performs it. So, you should not report this service separately on your spinal neurostimulator claims.

Tip 3: Report Codes 63663 and 63364 for Spinal Neurostimulator Revision

If your neurosurgeon revises a spinal neurostimulator, CPT^® also gives you specific codes for this service. Remember, in this case, CPT^® considers replacement an inherent part of the revision service, if your neurosurgeon performs it. These revision codes are as follows:

• 63663 (Revision including replacement, when performed, of spinal neurostim­ulator electrode percutaneous array(s), including fluoroscopy, when performed). Note: You should never report code 63663 in conjunction with codes 63361 or 63662 for the same spinal level. Additionally, you should never report 63663 when your neurosurgeon removes or places “a temporary percutaneously placed array for an external generator,” according to CPT^®.
• 63664 (Revision including replacement, when performed, of spinal neurostim­ulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed). Note: You should never report code 63664 in conjunction with codes 63661 or 63662 for the same spinal level.

As with the above codes, the revision code section includes a percutaneously placed neurostimulator (63663) where the contacts are located on a catheter-like lead. Also, with the open surgery choice (63664), the contacts are located on a plate or paddle-shaped surface.

Tip 4: Understand What Spinal Neurostimulator Codes Entail

In the guidelines, CPT^® clearly identifies the different parts of a spinal neurostimulator system. They are as follows:

• The implanted neurostimulator (pulse generator)
• An external controller
• An extension
• A collection of contacts on an electrode lead. Note: The contacts or electrodes (4 or more) are the component of the neurostimulator that provides the electrical stimulation for the spinal cord, per CPT^®.

Tip 5: Discover Electronic Analysis Options

If your neurosurgeon performs electronic analysis along with the programming of a spinal cord neurostimulator, you should look to the following codes:

• 95970 (Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/ off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming)
• 95971 (… with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional)
• 95972 (… with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/ transmitter programming by physician or other qualified health care professional)

However, CPT^® offers strict rules on how to properly report these electronic analysis codes.

Rule 1: There are numerous codes you should not report 95970 in conjunction with during the same operative session. This list of codes includes 63650, 63655, and 63661-63664.

Rule 2: You should never report code 95970 in conjunction with codes 95971 or 95972.

Rule 3: You should never report code 95971 in conjunction with code 95972.

Rule 4: If your neurosurgeon places a neurostimulator and performs a “test stimulation to confirm correct target site placement of the electrode array(s) and/or to confirm the functional status of the system” during the placement, you cannot separately report this service as electronic analysis or programming because CPT^® considered the testing to be a part of the neurostimulator placement service.

Rule 5: You should never separately report electronic analysis (code 95970) that your neurosurgeon performs when he implants a spinal neurostimulator.