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Wiki Spinal Cord Stimulator lead revision vs generator revision

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Wondering if spinal cord stimulator generator revision (cpt 63688) should be coded with spinal cord stimulator lead revision (cpt 63663). The procedure order and procedure documentation itself only describes lead revision due to leads moving. It is the same generator and same pocket, the only thing of note generator-wise is that it was removed from the pocket to reconnect the revised leads. What constitutes a generator revision in that kind of situation? Any articles on this situation to review would be appreciated. Thank you for your time!SCS lead revision.png
 
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My first thought was not to. I did not see any new device information including the Manufacturer, Model, Serial Number, etc. However, then when I read the CMS NCCI Manual, it seems to imply you can code it for opening it up, taking out the unit, attaching the new leads, and putting it back. They did have to make an incision, open it up, and reconnect, put back in the pocket, and close. They should get credit for that. It is "technically" revising it. The code 63688 is revision OR removal. See the highlighted sentence below.

CMS NCCI: https://www.cms.gov/files/document/08-chapter8-ncci-medicare-policy-manual-2026-final.pdf (search 63688 in here)

16. CPT codes 61885, 61886, and 63685 describe “insertion or replacement” of cranial or spinal neurostimulator pulse generators or receivers. Reporting an “insertion or replacement” CPT code necessitates use of a new neurostimulator pulse generator or receiver. CPT codes 61888 and 63688 describe “revision or removal” of cranial or spinal neurostimulator pulse generators or receivers. If the same pulse generator is removed and replaced (or relocated) into the same or another skin pocket, only the “revision” CPT code may be reported. The “replacement” CPT code which requires use of a new neurostimulator pulse generator or receiver shall not be reported. If one pulse generator is removed and a new pulse generator is inserted, only the “replacement” CPT code may be reported. The “removal” CPT code is not separately reportable. The “insertion or replacement” CPT code is separately reportable with a “revision or removal” CPT code only if 2 separate batteries/generators are changed in two separate locations. For example, if one battery/generator is replaced (e.g., right side) and another is removed (e.g., left side), CPT codes for the “insertion or replacement” and “revision or removal” could be reported together with modifier 59 or XU.

If you have CPT Assistant, there are articles about these codes. Example: https://www.ama-assn.org/system/files/cpt-assistant-neurostimulator-codes.pdf (Unfortunately, the clinical example in this link is only removal).
This is from Medtronic (take with a grain of salt) but it is saying you can report it too: https://www.medtronic.com/content/d...inal-cord-stimulation-reimbursement-guide.pdf "When the same generator is removed and then re-inserted, the “revision” code 63688 is used. NCCI Policy Manual 1/1/2023, Chapter VIII, C.16."

I don't have access to this site, but if someone does seems to be another answer here: https://www.zhealthpublishing.com/zquestions/view/20981
 
Good articles honestly, pretty helpful. When I read guideline 16, I'm not sure whether they are talking about it in the context of using 63688 with another code, like lead revision or just as a single reported code? That's my issue is everything I can find about 63688 with 63663 *would* be a true generator revision, but I'm really not sure that this is. Occasionally, you would have to open up the pocket to clean and check the generator more throughly but that would be if there was an issue with the pocket or generator during lead revision (infection, pocket expansion, replacing generator battery, or moving the generator to a new pocket). In that case, I would have coded them both but the provider didn't specify there was a generator unit issue before or during the procedure and when queried he stated it was just a lead revision. I'm half tempted to ask the provider again if he did any revising of the generator in his opinion, its his documentation and his procedure he should really have the final say I'm just coding what he did. I don't want to misrepresent the providers work. Hopefully we get some answers on the forums, I know the biller also has some forum posts in other places and I plan to do some more research today. About to start my weekend practicode struggle so I will try to target specialties where I may run into this kind of procedure. Also, I am pretty sure my boss asked an auditor at AAPC to review the situation as well to get their insight. Well see.... Thank you again and I will share this information with my team on Monday.
 
There is no P2P edit between 63663 & 63688. To me, the manual is literally saying to report the revision CPT 63688 for taking it out and putting it back into the same pocket.
Further, there is a "code also" note in CPT which states, "Code also insertion, removal, or revision of electrode array(s), when performed (63650, 63655, 63661-63664).
Other health plans may have a different policy on it. You would have to check specifics depending on who is being billed.

Refer to CPT Assistant December 2006 page 20. It was a question about 63685 + 63688 which can't be done; but also refers to a circumstance where the pulse generator is removed and the same one is reinserted. Then goes on to state that 63688 "may also be reported independently..." it is not a specific answer to the question, just more info.

Does the word "revision" in this case equate to: being revised because the pocket was incised, opened, unit removed, irrigated, and new leads attached, put back in, closed. Is it inherent? I don't know. Maybe. Would 63663 ever be expected to be reported alone? I don't know enough about these devices.

The Medtronic article has reference (talking about ASC) at the bottom to: The combination of code 63663 and 63688 qualifies for a complexity adjustment. Individually, code 63663 maps to APC 5462 and code 63688 maps to APC 5461, but when submitted together, the entire encounter is re-mapped to APC 5463. Similarly, the combination of code 63664 and 63688 qualifies for a complexity adjustment. Individually, code 63664 maps to APC 5463 and code 63688 maps to APC 5461, but when submitted together, the entire encounter is re-mapped to APC5464.

It's a good question.
 
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