Wiki Need help coding this SCS procedure


Best answers
I am having trouble coding a SCS procedure as I do not typically code these and I am hoping that there is someone on this list-serve that is knowledgeable in this area and would be willing to help me.

* A 2-lead spinal cord stimulator percutaneous implant.
* Implantable pulse generator (PG batter) implant with assistance. Intraoperative programming and analysis complex.
* Intraoperative fluoroscopy with interpretation.

After the patient was properly anesthetized and prepped and draped in the usual fashion the T12-L1 interspace was located bilaterally, 14-gaughe Tuohy needles were inserted from first the left and then the right side using a standard loss of resistance technique. Next, the medtronic subcompact lead was placed on one side and a compaq trial lead on the other side. It was easily navigated to the epidural space and up to the previous successful trial site, which was the very top of the T7 vertebral body at the 6-7 disk space. The leads were placed slightly higher to program in the middle and sort of at the top of the lead as in trial, so that the leads were covering T6 and T7 in entirety in a staggered fashion. Device was programmed and analyzed in a sterile fashion with the aid of the medtronic rep and found to be in excellent working order with good reproduction of the patients typical pain pattern reported while prone. At that point, the sedation was deepened and copious skin anesthesia was provided at the surgical sites and once the patient was resting comfortably the skin between the incisions was cut down to the fascia. The needles were exposed and removed. The leads were tied down to the fasica with 0 silk, 2 to 3 ties bilaterally using the medtronic titanium anchors. Tension release was applied by loop and then attention was turned to the battery site that previously had been anesthetized and previously been marked with the patient. It was cut down approximately 2cm deep. A pocket was created with a combination of blunt, sharp and bovie dissection. The incision was copiously irrigated. The battery was placed. It was analyzed through the skin with the aid for the company rep and found to be in perfect working order with normal impedance at 16 contacts.

1. I'm not sure if the coding should be 63650x1 or 63650x2 and 63685 and whether a 51 modifier is necessary.

2. Fluoro is not reportable since it is not documented, but what if it had been documented? Is it separately reportable?

3. I'm not sure whether 95971 or 95972 is the correct code or whether it is separately billable since it appears to be a normal part of the procedure.

4. L8680? I know nothing about these codes or when they are appropriate.

Would the coding differ based on Medicare or third party payer?

I do these neurostims for a pain management doctor and they usually code out to be 63650 (x2 in your case), 63685, and 95972. You would not append a -51 since more than likely the insurances will do that for you. Yes you can report the flouroscopy (77003-59-26) if it was documented. As far as the L8680 I'm not 100% positive since I don't code that because I think the hospital bills for it. It doesn't bundle with the other codes but that doesn't mean it's correct either for the doctor to bill for it. The coding is the same for all insurances. Hope this helps!
Are you coding for the doc? I code for an ASC, I use the 63650 for each lead, for medicare I use a 76 modifier although an audit stated a 59, bill for the unit 63685, doc bills for programming and for us flouro is inclusive. I use the L codes to get paid by commercial payers for the implants, did you supply the stimulator? These can be tricky because for us it depends on the payer! Let me know if you need more.
Thanks ewinnacott and juneh. This is only for the physician so I'm assuming I do not code the L codes.

I don't agree with ewinnacott that 77003 should be billed since there wasn't any documentation of fluoro being used AND because it is bundled into both 63650 and 63685.

I'm still not sure on 95972 since it appears from the documentation that the generator was run through diagnostics simply to make sure that it was working, and that it wasn't done as an actual diagnostic analysis of the generator. Am I incorrect on this?
I think you did not read my whole post. I said you can bill the 77003 if it was documented. It's up to you if you want to bill it or not. I've never had a problem with it.
for the L8680, if the doctor does it in the office, we bill for it because the doctor paid for them, and we haven't had problems getting any insurance including Medicare to pay for them. However, if it is in a facility/hospital, then they usually buy the leads, so it is not billable for the physician.