Wiki 63663

[574coding]

Hi,
Question...We had a patient that came in for a SCS revision. The generator and 2 leads were explanted and a new generator and 2 leads were implanted.
We billed out 63685 and 63663.
Medicare paid on the 63685, but did not pay the 63663.
I know the LCD says "Noridian will reimburse for placement of a maximum of 2 leads or 16 “contacts”, and for 2 SCS trials per anatomic spinal region per patient per lifetime."
So my thought is the leads will not be reimbursed and we should be happy with the payment for the generator. Any other info you may have to share on this before I let the collector know that they will not be able to appeal this?
Thanks

 

[dwaldman]

You could appeal it and state the reason the leads had to be replaced. When they state a maximum of 2 leads I was thinking that was 2 leads total during an implantation, it does not appear to address if those leads need to be replaced. I would review the limited warranty and determine if the rep was notified and what the rep believe if there was malfunction with the leads and if they would fall under a warranty depending on when they were placed. I think addressing when they were initially placed what the manufacturer's warranty is and whether they are covered under warranty, and reason they are being replaced would be helpful information.