Wiki Spinal Neurostimulator

[Denise M]

Need assistance, out patient surgical center, How to code properly Spinal Neurostimulator with and without Trial for Commercial and Medicare Carriers? Thank you in advance, any help will be appreciated.

 

[spahutski]

billing in ASC

trial stimulators Medicare 63650 x 2, second line needs a 76 modifier, each line is paid at 100%, for stimulators there is not a 50% write off for second line.
Commercial 63650 x 2, C1778 for lead implant

perm stimulators Medicare 63685, 63650 x 2 with a 76 modifier on second code and again each line is paid at 100%
Commercial 63685, 63650 x 2, C1822 for HF generator, C1820 for non HF generator, C1778 for leads.

Also check LCD's for these codes.
Medicare will request records for these procedures, so make sure you have MRI's and a Psych evalution along with notes showing the % of relief from the trial.
Hope this helps.
Sharon

 

[miracle01]

Need assistance, out patient surgical center, How to code properly Spinal Neurostimulator with and without Trial for Commercial and Medicare Carriers? Thank you in advance, any help will be appreciated.

76 modifier is not correct!

Medicare (I am in J5 and WPS is our MAC) this is how I bill it

63650
63650-59
It allows 100% for each line, the implanted material is inclusive and not billed separately.

Commercial after pre-authorization is obtained....

Our commercial plans require billing L8699 for any implants and I send in the invoice with the claim and bill it per our contract.
63650
63650-59
L8699 (however many you use go in the unit field)

Usually commercial pays using the multiple procedure discount.

Hope this helps.

 

[dawnsouthard]

billing in ASC

trial stimulators Medicare 63650 x 2, second line needs a 76 modifier, each line is paid at 100%, for stimulators there is not a 50% write off for second line.
Commercial 63650 x 2, C1778 for lead implant

perm stimulators Medicare 63685, 63650 x 2 with a 76 modifier on second code and again each line is paid at 100%
Commercial 63685, 63650 x 2, C1822 for HF generator, C1820 for non HF generator, C1778 for leads.

Also check LCD's for these codes.
Medicare will request records for these procedures, so make sure you have MRI's and a Psych evalution along with notes showing the % of relief from the trial.
Hope this helps.
Sharon

for C1778 do you put the amount of electrodes in the units? For example if we did a bilateral trial neurostimulator with 16 lead electrodes would we put 32 in the units or 2 for 2 separate paddles?