Repositioning of SCS Trial Leads

574coding

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Our provider implanted SCS trial leads-code 63650 on the 26th of the month. Patient was sent home with leads and a external generator. On the 29th day of the month, pt was back in the ASC and the provider reposition the leads. Same leads, just moved contacts for pain coverage.

What is the correct way to bill this? Is 63663 only for permanent leads? Is repositioning the leads included in the trial like removal of trial leads are? I am a bit confused on how to code this. Would you use 63650 with modifier 52 for reduced services?

Thank you for your time.
 

dwaldman

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Below is from AMA CPT Assistant April 2011, reviewing the below it does not appear 63663 can be reported for temporary lead revision. I would believe it would inclusive similar to how 63661 is inclusive when working with a temporary lead/array.

Do not report 63661 or 63663 when removing or replacing a temporary percutaneously placed array for an external generator.

Question 2: What CPT codes are reported when a temporary “percutaneous” electrode array is removed with the insertion of a permanent percutaneous electrode array and an implanted pulse generator or receiver at the same operative session?
AMA Response: The revision of a percutaneously implanted system (code 63663) would only be performed after a permanent electrode array is in place and is later revised. As indicated in CPT Assistant August 2010, if during the trial period a level of pain relief has been achieved, a decision may be made to place a permanent electrode array. If the percutaneous trial electrode is removed and a new percutaneous permanent implant is placed, this constitutes placement of a new percutaneous implant, which would be connected to an implanted pulse generator. Procedurally, this would not be a revision. It would not be appropriate to report code 63663, Revision including replacement, when performed, of spinal neurostimuator electrode percutaneous array(s), including fluoroscopy, when performed, because neither this type of electrode plate nor paddle was previously in place. Code 63663 would only be used if a previous permanent (internalized system) array of neurostimulator electrodes had been percutaneously placed, and is now being revised or replaced to improve efficacy.
The work of removing a temporary percutaneous lead array is valued within the code for the “initial” placement (63650). Therefore, it would not be appropriate to report code 63661, Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed, when removing the percutaneous trial electrode. The placement of the permanent percutaneous neurostimulator electrode array would be reported using code 63650. Based on payer requirements, if performed during the postoperative period of the initial percutaneous electrode insertion (code 63650), it may be necessary to append CPT modifier 58, Staged or Related Procedure or Service by the Same Physician During the Postoperative Period.
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574coding

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Do you think it would be correct coding to report 63650-52-78 for the repositioning of the leads? Reduced services on a unplanned procedure by same Physicians during the postop period...
Thank you for your help with this.
 

dwaldman

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I would bill it as 99024, reviewing your question again, I don't believe it would represent 63650-52.
 
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