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trial stimulator vs placement of permanent stimulator

  1. #1
    Default trial stimulator vs placement of permanent stimulator
    Medical Coding Books
    I am new to the auditing field and I came across a note where the physician inserted a trial spinal cord stimulator, it was coded as 95971/77003 the patient came back 3 days later and had a f/u which was coded as 99215, then the pre-op note and ultimately i will see the charges for the actual implant.
    i am totally confused as i was used to see only the placement 63650 with L8680 x2 not L8680 X16 and now i can't wait to see how are they going to charge for the actual placement
    any good thoughts or references out there? I was coding for ASC
    Angelica Stephens RHIT, CPMA, COSC, CCS-P, CPC, COC.
    Albuquerque, NM

  2. #2
    Following the placement of a percutaneous SCS trial array/lead, the post op period would include 10 day period in which visits that could include removal of the array/lead, feedback from the patient of possible decrease in the pain level ("I feel better; my pain went from a 9 to a 5") or possible adverse response to having the temporary implanted lead ("I having an unfavorable response; I would like it removed")
    As seen in this link below under payment policy indicators for 63650 (global period 10)

    Below on page 49, modifier 24 would have to be reviewed for unrelated E/M encounter during the post op period.

    30.6.6 - Payment for Evaluation and Management Services Provided During Global Period of Surgery

    In the April 2011 CPT Assistant, it is questioned whether 95971/95972 can be reported for temporary leads that have been attached to an external pulse generator. The AMA response was:

    "An inherent portion of the lead placement and is not additionally reported using either code 95971 or 95972, is electronic analysis during a percutaneous electrod array placement (63650) or druing a laminerctomy for implantation of plate/paddle electrode array (63655) when only impendence testing an stimulation is performed to verify function of the leads (not the pulse generator)."

    In December 2010 CPT Assistant, in regards to fluoroscopy reported in addition to percutaneously lead placement the AMA responded:

    "Fluoroscopic guidance (codes 76000 and 77003) is considered inherent in the performance of the percutaneous implantation of the neurostimulator electrode array in the epidural space as represented by code 63650, Percutaneous implantation of neurostimulator electrode array, epidural. Therefore, it is not appropriate to additionally report the fluoroscopic guidance."

  3. #3
    L8680 x 16 would be "each electrode" for a placement of two arrays with 8 electrodes on each array

    Below this link is also helpful, the fine print has some CMS, AMA, and NASS references/clarfication

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