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Removal Stimulator Generator/receiver

  1. #1
    Default Removal Stimulator Generator/receiver
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    We did a removal and replacement of a pulse generator on a stimulator that was implanted several years ago by a different physician.

    Is it just 63685, or 63688 and 63685?

    I think 63685, but doc thinks both can be billed.

  2. #2
    Default
    63688 (removal) is a component of 63685 (replacement) if at same location. 63688 is not separately billable per NCCI edits.

    Julie, CPC
    Last edited by jdrueppel; 05-13-2009 at 08:50 PM. Reason: typo

  3. #3
    Location
    North Carolina
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    Per CPT Assistant~

    "This instruction refers to the circumstance where a pulse generator is removed and the same generator is reinserted. For example, the pulse generator is removed due to disconnection of the lead(s), the lead(s) are reconnected, and the same generator is reinserted. Another example is in the event the generator is resting on the pelvic rim and is moved due to pain. In these two specific circumstances, the work is considered revision of an existing generator so only code 63688, Revision or removal of implanted spinal neurostimulator pulse generator or receiver, should be reported. It would not be appropriate to report code 63688 for removal of the generator in addition to code 63685, Insertion or replacement of spinal neurostimulator pulse generatoror receiver, direct or inductive coupling, to describe reinsertion of the same generator. To further clarify, code 63688 may also be reported independently, for example, in the event of infection or because a satisfactory response to treatment has not been achieved. In this circumstance, for removal of the lead array, code 63660, Revision or removal of spinal neurostimulator electrode percutaneous array(s) or plate/paddle(s),should also be reported."
    Last edited by RebeccaWoodward*; 05-11-2009 at 03:48 PM.

  4. #4
    Default
    Rebecca,
    I've read that CPT Assistant excerpt but even taking into account the CPT parenthetical "Do not report 63685 in conjunction with 63688 for the same pulse generator or receiver" I'm not sure how to get around the NCCI edits as 63688 is bundled into 68685 and no modifier is allowed for
    over-ride. I was at the University of Chicago Anesthesia meeting in Las Vegas in March and there was plenty of discussion regarding these codes. The final advise from Joanne Mehmert, the ultimate pain coding guru in my opinion, was to get written clarification from each payer and bill accordingly.

    Julie, CPC

  5. #5
    Location
    North Carolina
    Posts
    3,126
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    I agree with you Julie. Unfortunatley, carriers create needless hurdles for these particular procedures. We can be at the mercy of their policies.

  6. Default Spinal stimulator removal generator/receiver
    Can we bill 63688 and 63685 together?

    Rebecca Woodward cited a CPT assistant and quoted it. I need to find that CPT assistant to print it for proof. Is Rebecca "listening" or does anyone know what issue of CPT assistant that I can find this article.

    Thank you!!!
    Mary

  7. #7
    Default
    15. CPT codes 61885, 61886, and 63685 describe “insertion or replacement” of cranial or spinal neurostimulator pulse generators or receivers. 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 into the same or another skin pocket, the “replacement” CPT code may be reported. The “removal” CPT code is not separately reportable. Similarly, if one pulse generator is removed and replaced with a different pulse generator into the same or another skin pocket, 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 two separate batteries/generators are changed. [B][U]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

    _________________________________________
    Above is from the NCCI policy manual, I didn't see the coding scenario described in April 2011 SCS article with multiple Q and As

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