K Posted Wed 13th of April, 2016 14:26:12 PM
Question...We had a patient that came in for a SCS revision. The generator and 2 leads were explanted and a new generator and 2 leads were implanted.
We billed out 63685 and 63663.
Medicare paid on the 63685, but did not pay the 63663.
I know the LCD says "Noridian will reimburse for placement of a maximum of 2 leads or 16 “contacts”, and for 2 SCS trials per anatomic spinal region per patient per lifetime."
So my thought is the leads will not be reimbursed and we should be happy with the payment for the generator. Any other info you may have to share on this before I let the collector know that they will not be able to appeal this?
SuperCoder Answered Thu 14th of April, 2016 03:10:11 AM
Please refer to the following CPT assistant link as it would be helpful in coding CPT 63685.
K Posted Thu 14th of April, 2016 10:41:02 AM
I UNDERSTAND CODING 63685, THAT IT THINK WAS OK, UNLESS I AM MISSING SOMETHING IN THE CPT ASSISTANT LINK. IF SO, WOULD YOU PLEASE BE ABLE TO POINT IT OUT TO ME. IT IS MORE A ISSUE WITH 63663 AND IF MEDICARE WOULD COVER THIS DUE TO THE LCD
SuperCoder Answered Mon 18th of April, 2016 04:46:49 AM
As per the LCD criteria by Medicare CPT 63663, this CPT will not be billed due to the reason given by Medicare. It will not be billed.