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Cpt Code 63660 Descriptive Essay

Officially done with my 8 page research paper for my world civ class.

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Coding Spinal Cord Stimulator

There is insufficient information in the question to code appropriately, but you can find general information regarding appropriate coding for trial and permanent spinal cord stimulator in the April 2011 CPT® Assistant. In part, the article explains:

Question 1: May code 63650 be reported for both insertion of a temporary percutaneous electrode array and a permanent percutaneous electrode array?

AMA Response: Yes. The use of code 63650, Percutaneous implantation of neurostimulator electrode array, epidural, is not altered when the implantation of the percutaneous epidural neurostimulator electrode is performed for the purpose of a “temporary” trial or for “permanent” neurostimulation. The difference between the two procedures is the attachment of the electrode array to an external stimulator unit for trial stimulation as opposed to connecting to an implanted pulse generator or receiver for permanent stimulation. Attachment to an external stimulator unit is considered inherent to the work represented by code 63650. Therefore, it is not appropriate to report code 63685, Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling.

However, if the percutaneous electrode array is attached to an implanted spinal neurostimulator pulse generator or receiver, then code 63685 would be reported in addition to code 63650, for the insertion or replacement of the pulse generator or receiver. Code 63685 includes the creation of a subcutaneous pocket made to house the stimulator and tunneling of the electrodes to the pocket. The generator is then placed in the subcutaneous pocket, lead impedances are tested to verify proper connection, and the device is programmed to begin stimulation (code 95972). (Refer to Question 3 for further information related to the use of code 95972.)


Question 2: What CPT codes are reported when a temporary “percutaneous” electrode array is removed with the insertion of a permanent percutaneous electrode array and an implanted pulse generator or receiver at the same operative session?

AMA Response: The revision of a percutaneously implanted system (code 63663) would only be performed after a permanent electrode array is in place and is later revised. As indicated in CPT Assistant August 2010, if during the trial period a level of pain relief has been achieved, a decision may be made to place a permanent electrode array. If the percutaneous trial electrode is removed and a new percutaneous permanent implant is placed, this constitutes placement of a new percutaneous implant, which would be connected to an implanted pulse generator. Procedurally, this would not be a revision. It would not be appropriate to report code 63663, Revision including replacement, when performed, of spinal neurostimu-lator electrode percutaneous array(s), including fluoroscopy, when performed, because neither this type of electrode plate nor paddle was previously in place.

Code 63663 would only be used if a previous permanent (internalized system) array of neurostimulator electrodes had been percutaneously placed, and is now being revised or replaced to improve efficacy.The work of removing a temporary percutaneous lead array is valued within the code for the “initial” placement (63650). Therefore, it would not be appropriate to report code 63661, Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed, when removing the percutaneous trial electrode.
The placement of the permanent percutaneous neurostimulator electrode array would be reported using code 63650. Based on payer requirements, if performed during the postoperative period of the initial percutaneous electrode insertion (code 63650), it may be necessary to append CPT modifier 58, Staged or Related Procedure or Service by the Same Physician During the Postoperative Period.

Code 63685 should be reported in addition to code 63650 to describe the implantation of the pulse generator and percutaneous electrode array connection.
Nonetheless, if the trial percutaneous electrode array is neither removed nor replaced, but is simply connected to an implanted pulse generator (IPG), only the insertion of the IPG is reported (code 63685). The work of connecting the percutaneous trial electrode to the IPG is included in code 63685. (Refer to Question 3 for further information related to initial programming at the time of implantation (code 95972).)