sharonc2222
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When billing Medicare for CPT code 63361 for spinal cord stimulator lead removal, Medicare only allows 1 unit. Surgeon removed 2 leads. The code does not allow for bilateral modifier 50. Is there a way to bill for 2? Was considering modifier 22 but since only 1 is allowed, we would need to appeal with the documentation to Medicare, which I am not sure the note is sufficient or if it's wasted time due to the allowance of 1 unit regardless. See below for operative note summary. We were paid for all codes billed except the second electrode/lead removal. Read description below. Thanks!
PROCEDURES:
1. Removal of spinal cord stimulating electrode (2).
2. Removal of internal pulse generator.
3. Placement of intrathecal pain catheter.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room,
correctly identified, placed under general endotracheal anesthesia by the
anesthesia service. The patient was then repositioned prone. All
pressure points were padded. The thoracic and lumbar regions were
sterilely prepped and draped. Fluoroscopy was brought into the field
using sterile technique. The thoracic incision was opened. Dissection
carried deeper to expose spinal cord stimulating electrode and anchor.
These were freed and removed from the spinal canal. The second electrode
migrated out of the canal and was coiled around the internal pulse
generator. Both anchors were also removed.
Attention was then turned to the internal pulse generator where the
incision was reopened and the internal pulse generator and remaining
stimulating electrodes were removed. At this point, fluoroscopy was again
used to confirm all components were removed from the patient. Both
incisions were irrigated with antibiotic solution and closed in layers.
A Tuohy needle was advanced to the lumbar cistern. Gentle aspiration
revealed clear CSF. An intrathecal catheter was then threaded in a
cranial trajectory and this again was confirmed with fluoroscopy. The
needle and stylet were removed and the catheter was secured to the
patient's back.
PROCEDURES:
1. Removal of spinal cord stimulating electrode (2).
2. Removal of internal pulse generator.
3. Placement of intrathecal pain catheter.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room,
correctly identified, placed under general endotracheal anesthesia by the
anesthesia service. The patient was then repositioned prone. All
pressure points were padded. The thoracic and lumbar regions were
sterilely prepped and draped. Fluoroscopy was brought into the field
using sterile technique. The thoracic incision was opened. Dissection
carried deeper to expose spinal cord stimulating electrode and anchor.
These were freed and removed from the spinal canal. The second electrode
migrated out of the canal and was coiled around the internal pulse
generator. Both anchors were also removed.
Attention was then turned to the internal pulse generator where the
incision was reopened and the internal pulse generator and remaining
stimulating electrodes were removed. At this point, fluoroscopy was again
used to confirm all components were removed from the patient. Both
incisions were irrigated with antibiotic solution and closed in layers.
A Tuohy needle was advanced to the lumbar cistern. Gentle aspiration
revealed clear CSF. An intrathecal catheter was then threaded in a
cranial trajectory and this again was confirmed with fluoroscopy. The
needle and stylet were removed and the catheter was secured to the
patient's back.