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How to code a device intensive procedure when the device is not implanted

Marianne Posted Thu 23rd of May, 2013 18:09:52 PM

The surgeon was implanting a spinal cord neurostimulator. One lead, 63650 was attempted to be implanted, he could not manuver it into the space, so he attemped a second/different lead with success. We were still charged for the first lead that could not be implanted. Can I bill for the scraped lead with 63650 and a modifier to show it was attempted but not sucessful? Modifier ??? Not sure -52 is appropriate.(?)

SuperCoder Answered Tue 28th of May, 2013 23:40:35 PM

Hi,

I am taking the advice from my editor to be sure before delivering it to you.

Thanks for being patient.

Marianne Posted Wed 29th of May, 2013 15:34:46 PM

....in addition to this question, charge me for a seconded question if you need to but its related/similar. The patient had neurostimulator leads in place. He came back for a revision or replacement. The surgeon attempted to put in two new leads, with out success and ended up removing original leads and NOT placing the second leads. Being the final outcome was lead removal, do I bill for the lead removal only 63661 or do I bill for a lead revision 63663 with a modifier since that is the more extensive procedure but includes the cost of the array/lead ? My dilema is the same, the codes are device intensive, but the implants are not left if at the end of the procedure. Thanks for your help, we are stumped on this one.

SuperCoder Answered Thu 30th of May, 2013 17:33:42 PM

For the first question--

Code 63650 represents placement of a percutaneous neurostimulator electrode array. Physicians often insert a temporary lead to ensure the treatment will work for the patient. Once the viability is confirmed, the physician removes the temporary lead and implants a permanent neurostimulator. The work associated with removing the temporary lead is included in the placement represented by 63650 (CPT Assistant, August 2010).

It’s not uncommon for physicians to place more than one temporary lead during an encounter, in different anatomic sites. This could be the reason why current CCI edits allow you to report multiple instances of 63650 on the same date of service. If you do this, however, the payer will assume the physician placed the leads in multiple locations, not the same site because of needing to start the insertion fresh.

Appending modifier 52 (Reduced services) indicates that the inherent procedure represented by the code was completed, but lacked a bit of the usual included service. That might not be the best representation of the procedure since your physician wasn’t able to get the first lead into the space for placement.

The first lead’s attempted placement possibly was involved enough to bump up the work associated with the successful second placement, but not enough to stand on its own as a “reduced services” procedure. Therefore, your better option might be to report one unit of 63650 with modifier 22 (Increased procedural services) . Include documentation to explain the situation and justify appending modifier 22.

Marianne Posted Thu 30th of May, 2013 19:32:25 PM

Modifier -22 is a physician modifier. This is for the facility side.

SuperCoder Answered Mon 03rd of June, 2013 20:57:53 PM

For the Second Question-

I think the first thing we need to clarify when answering this follow-up question is whether the original neurostimulator that has now been removed was a temporary device. If so, the fee and work involved in removing it are included in the original placement code of 63650. That would mean she doesn't need to bill for the current removal.

If the neurostimulator being removed was already a permanent type placement, then I think you could report its removal/revision. I would submit 63661 for removal instead of 63663 for revision -- nothing was revised to qualify for 63663.

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