Question SCS Help

brooke23

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Hello, I am new to pain coding and needing some guidance for coding that is rejecting by Medicare. The codes billed were 63650,63685 and 95972. Can these be billed together and do they need modifiers?

1. Implantation of spinal cord stimulator leads for permanent stimulation X 2
2. Implantation of IPG battery
3. Complex spine programming less than 30 minutes

Thanks in advance for your help!
 

medlcg79

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Hello, I am new to pain coding and needing some guidance for coding that is rejecting by Medicare. The codes billed were 63650,63685 and 95972. Can these be billed together and do they need modifiers?

1. Implantation of spinal cord stimulator leads for permanent stimulation X 2
2. Implantation of IPG battery
3. Complex spine programming less than 30 minutes

Thanks in advance for your help!
The complex spine programming would be included and does not get billed separately. For the leads you'd bill 63650 x2 and for the battery it would be 63685. This is the way I bill it; without any issues since 2006. Back in the day we would also include the L codes for the leads and battery. But for Medicare these are now included in the CPT code and are no longer billed separately.
 
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brooke23

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The complex spine programming would be included and does not get billed separately. For the leads you'd bill 63650 x2 and for the battery it would be 63685. This is the way I bill it; without any issues since 2006. Back in the day we would also include the L codes for the leads and battery. But for Medicare these are now included in the CPT code and are no longer billed separately.
 

medlcg79

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Thank you for the clarification. Do they need the modifiers as well?
modifiers are not required or needed. Unless the procedure was aborted (53 professional or 74 facility) or if it's global (58,78,79 or global does not apply to ASC) to another procedure. I bill for both the ASC and Professional component. Not sure which one you're billing for, but I've included information for both.
 

medlcg79

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Yes, even for Medicare, 63650 is normally line item billed.
Per the MUE 63650 has a value of 2 and the MUE adjudication indicator is "3 Date of Service Edit: Clinical" Therefore, this indicates the units billed on the entire date of service will be compared to the MUE (not per claim line). Units in excess of the MUE are unlikely, but in rare circumstances can be billed on separate lines with a modifier...
 

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modifiers are not required or needed. Unless the procedure was aborted (53 professional or 74 facility) or if it's global (58,78,79 or global does not apply to ASC) to another procedure. I bill for both the ASC and Professional component. Not sure which one you're billing for, but I've included information for both.
I am also looking for help in this area. I bill for an ASC as well. We have a revenue cycle company telling me they think I can also bill HCPCS codes along with the 63685 code. I told them I believe this is included in the code. Can you help clarify this please? Any help with this would be greatly appreciated.
 

medlcg79

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I am also looking for help in this area. I bill for an ASC as well. We have a revenue cycle company telling me they think I can also bill HCPCS codes along with the 63685 code. I told them I believe this is included in the code. Can you help clarify this please? Any help with this would be greatly appreciated.
It's been my experience that we can bill the HCPCS to commercial payors. Medicare includes the payment for the equipment in the CPT code and will not pay HCPCS codes separately.
 
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They follow Medicare guidelines, therefore, will not pay. You can try, but I believe it will be denied. Another thing I wanted to mention is to be sure to have the invoice handy. They will typically ask for it.
Yes, I always get a copy of that, I was pretty sure I could not get more reimbursement with those as well. Thanks again for your help!
 

elopezmanager

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Hi everyone. Good conversation. I always bill mine on 2 lines with Rt and Lt and get paid for all my payers. But i do have another question. My provider is starting to do SCS trials for pts that have not had spinal surgery and some do not have radiating pain. I am concerned about this. The only backup that I have is that they went to a neurosurgeon and I have a progress note that says what the recommendation is, which includes SCS. But my provider does not want to use the diagnosis that the neurosurgeon used/assessed for the reason to do a trial. I have check the diagnosis the neurosurgeon gave us and it is part of the LCD. Should insist on the neurosurgeons dx or use what my provider gives my, for ex., M54.17, when there is no radiating pain?
 
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