SCS CPT coding

[jwheezy]

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Because my coders at my hospital are terrible and are always dropping codes for no reason, wanted to float this out to everyone...

I recently performed a SCS revision. Patient had previously implanted system both leads were left sided due to scoliosis. No right sided coverage where needed. we performed a trial because he's extremely scoliotic to ensure we place correctly during implant to get right sided coverage. We go to OR, upgrade his IPG, removed 1 LEFT sided lead, and implant a new RIGHT sided lead. Does great.

I coded for 63650 x 1, 63661 x 1, and 63685. My coders are dropping the 63661 because they state 63650 is inclusive of 63661 but my understanding is that is the case cause of trial lead removal, not removal of a previously implanted lead. At the very least it should have been coded as a revision 63663.

Any thoughts from the group?

 

[buddababa]

coders are correct, you cant do 63650 with 63661 and 63663, and 63663 includes 1 lead revision or 10 lead revision. so your surgery should be coded as 63663x1 and 63685x1

 

[mdo1738]

Hospital based here too, I can’t tell you if the hospital does indeed get paid for these codes but, for any revision, I always code 63661 x2 for removing the old leads and 63650 x2 for inserting the new leads. Then 63685 for the IPG and 95972. I always get the RVUs.

Frankly, I was unaware of the existence of 63663 until your post. It is insulting that they think surgical electrode explantation is worth less than $50. Obviously, many other codes pay insulting amounts too.

From what I can find, I think your coders are unfortunately right. But I would fight it on principle and semantics. You are not “revising” an existing electrode. You are removing an old electrode, which undeniably is 63661. And you are placing a new electrode, which undeniably is 63650.

 

[buddababa]

Hospital based here too, I can’t tell you if the hospital does indeed get paid for these codes but, for any revision, I always code 63661 x2 for removing the old leads and 63650 x2 for inserting the new leads. Then 63685 for the IPG and 95972. I always get the RVUs.

Frankly, I was unaware of the existence of 63663 until your post. It is insulting that they think surgical electrode explantation is worth less than $50. Obviously, many other codes pay insulting amounts too.

From what I can find, I think your coders are unfortunately right. But I would fight it on principle and semantics. You are not “revising” an existing electrode. You are removing an old electrode, which undeniably is 63661. And you are placing a new electrode, which undeniably is 63650.

agree with you, but with my P2P with aetna and uhc and others, they only allow 63663 x1 for a revision. which is frustrating for the amount of work it takes

 

[BobBarker]

On full explant, implants I typically try to bill it 63650x2, 63685 just like a primary implant. It generally works.

 

[Orin]

I coded for 63650 x 1, 63661 x 1, and 63685. My coders are dropping the 63661 because they state 63650 is inclusive of 63661 but my understanding is that is the case cause of trial lead removal, not removal of a previously implanted lead. At the very least it should have been coded as a revision 63663.

I think you are correct.

63650 - is lead implant w/o lami
63661 - is lead removal w/o lami
63663 - is lead revision and/or replacement. This would be most appropriate.

You may want to update your operative note to be precise about what you did. There were two implanted leads. Lead 1 was removed. Lead 2 was left in place. Lead 3 was placed with a new approach/etc. A new IPG pocket was created and a new IPG placed. The leads were directly connected to the fresh leads.

The issue is the hospital site of service only lets you bill the top-line code, so they really are only billing for the 63685 and/or the 63663 and the rest is just capturing your productivity

Mine lets me drop all the CPT codes I want in the EMR so I'm trying to do all the 4 lead DRG explants I can....