Reader Question:
Deep Brain Stimulators
Published on Tue Oct 01, 2002
Question: What is the proper coding for implantation and programming of deep brain stimulators for treatment of Parkinson's disease? Vermont Subscriber Answer: CPT revised the codes for these procedures in 2000:
61850 Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical
61860 Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical
61862 Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of one neurostimulator array in subcortical site (e.g., thalmus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray)
61885 Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
61886 with connection to two or more electrode arrays Note: Codes 61855 and 61865, previously used to report approach procedures, have been deleted and replaced by 61862. The approach should be reported using either 61850, 61860 or 61862, depending on method. According to CPT Assistant, November 1999, 61860 describes implantation of neurostimulator electrodes in a cortical site by craniectomy or craniotomy, while 61862 describes stereotactically placed subcortical deep brain stimulation insertion by twist drill, burr hole, craniotomy, or craniectomy technique. The latter includes placement of a stereotactic frame, with determination of placement and/or alignment by CT or MRI scanning. Code 61850 describes insertion by twist drill or burr hole without stereotactic guidance. Note: The "cortical" stimulation codes (61850 and 61860) are usually used for placement of brain stimulators to treat epilepsy, not Parkinson's disease. Use 61885 or 61886 to describe the actual placement of the neurostimulator(s). Each involves "internalization of the tail of the electrode array and placement and connection of a subcutaneous neurostimulator generator for long-term brain stimulation," according to CPT Assistant. Code 61886 "differs in that the same insertion procedure is repeated for the electrode array on the other side, including tunneling of the tail of this electrode to the second limb of the bifurcated extension wire."
The local medical review policy (LMRP) published by Cigna Healthcare, the Medicare Part B carrier for North Carolina, specifies that a diagnosis of 332.0 (Paralysis agitans [idiopathic Parkinson's disease]) or 333.1 (Essential and other specified forms of tremor) must accompany the claim. Other Medicare carriers follow similar or identical guidelines. The neurostimulator insertion codes do not include evaluation, testing, programming or reprogramming. Report these separately, using codes from the 95970-95975 series, as appropriate. Note: Codes for subsequent removal or revision of the DBS unit include 61880(Revision or removal of intracranial neurostimulator electrodes) and 61888 ( of cranial neurostimulator pulse generator or receiver). Code 61880 would include repositioning of the electrode to enhance function or to respond to a progression of the disease.
