Neurosurgery Coding Alert

Question: Recently, I reported 63655 x 3 (levels T10-T11-T12) for laminectomies to place neurostimulator electrodes. The payer denied all but a single level. I refiled, sending the complete op report, but the insurer still refuses to pay for the additional levels. Do we have any recourse?


Virginia Subscriber


Answer: Although you and your surgeon may be disappointed, the payer's actions are defensible in this case.

The descriptor for 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) does not indicate "per level," and neither are there add-on codes to describe additional levels beyond the first (as is true of many spinal surgery codes). Rather, as written, the descriptor defines a laminectomy (without regard to the number of levels) for neurostimulator electrodes (note the plural) implantation.

In other words, 63655 is a "regional" code, and a single unit describes the implantation of the electrodes, regardless of how many levels the surgeon has attended to. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University Department of Surgery.