Wiki SPINAL CORD STIMULATOR QUESTION

jamiepeters

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KLAMATH FALLS, OR
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A patient came to see our provider with a spinal cord stimulator already implanted from several years ago and that was now malfunctioning. Our provider was unable to get an MRI due to the compatibility of the stimulator with the MRI. The decision was made to remove the old stimulator then get an MRI and then make a decision about a new stimulator. After the original one was removed our provider gave the patient a trial stimulator and after that it was decided to implant a new unit. The old electrodes were percutaneous and the new electrodes are plate/paddle. We billed Medicare for the removal of the old and got paid with no problem, we then billed Medicare for the trial and got paid with no problem. We then billed Medicare for the new stimulator using CPT codes 63655 and 63685 however only the 63685 was paid. Medicare denied the 63655 as payment already made for same/similar procedure within set time frame. After getting this denial I was able to find that Medicare will only pay for the 63655 once in the lifetime of the patient. So does anybody know if the same is true for the CPT code 63664 (percutaneous) and if the once in a lifetime is for either one? or can the patient get 63664 once and 63655 once?
Does anybody know how else we should of coded this? I have a feeling that the provider should of done a revision including replacement (63663 or 63664) instead of removing the old unit in the first procedure.
Any help with this would be greatly appreciated.
 
Hi there, I believe that 63664 is the correct code, but for full details you should check Noridian's LCD and LCA.
 
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