Although coding in this area may seem complex, you can
simplify it with a quick review of requirements and carrier policies.
Coding for spinal cord stimulation lead implantation is thought to be too complex and difficult for some. There are several reasons for this perception: There are coding differences based on the site of service and there is a unique requirement that patients must undergo a trial phase prior to receiving the permanent implantable device therapy.
Code the Leads
There are two types of neurostimulator leads:
63650 Percutaneous implantation of neurostimulator electrode array, epidural
63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
A percutaneous lead is inserted via needle into the epidural space. There is a version used for the trial phase and a version used for permanent implantation. The same CPT® code is used for both types of percutaneous leads. When more than one lead is used, each lead is coded separately using 63650. Modifier 59 Distinct procedural service may be appended, although there is a multiple procedure reduction (MPR) in some settings for some payers and there is a medically unlikely edit (MUE) of 2. The modifier does not override the MPR or the MUE. CPT® 63650 is considered a minor surgical procedure with a global period of 10 days.
A paddle lead is implanted via laminectomy and may be used for a staged trial, depending on the nature and severity of the patient’s condition. This is the only procedure related to spinal cord stimulation that is not considered a minor surgical procedure. It is considered a major surgical procedure with a global period of 90 days. This code may also be subject to an MPR in some settings for some payers and the MUE is 1. Modifier 59 may be appended if more than one lead is used, but it does not impact the MPR or MUE.
If the permanent implant is done within the 10-day global period, append modifier 58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period. It is considered an appropriately staged procedure due to the trial being a requirement of the therapy.
Capture the Place of Service
Percutaneous trials can be performed in the physician office, the hospital outpatient setting, or the ambulatory surgery setting. Paddle lead trials involving laminectomy and permanent implants must be performed in the hospital outpatient or ambulatory surgery (facility) setting. The lead implantation codes 63650 and 63655 may be used for both the trial and permanent implant stages.
CPT® 63650 can be billed either on two separate lines or on one line with a quantity of 2, 3, etc.
Check National and Local Policies
For more information and additional guidance, there is a Center for Medicare & Medicaid Services (CMS) National Coverage Determination (NCD) for Electrical Nerve Stimulators (160.7) that describes the Medicare conditions of coverage. These conditions of coverage appear in every local Medicare Administrative Contractor (MAC) Local Coverage Determination (LCD), as well as most commercial payer policies. The LCDs and payer policies provide more specific coding information than the NCD. As a coder, these policies and other resources, such as CPT® Assistant, are excellent for clarification if you are unsure how to code for a specific spinal cord stimulation scenario.
About the contributor
Kathleen O’Neill, MBA, COC, is senior manager, Health Policy & Reimbursement at Nuvectra Corporation. She has a Master of Business Administration from Widener University in Pennsylvania. O’Neill has worked in health policy and field reimbursement for the medical device industry for over 17 years, in the wound management, biologic, cardiac, and neuromodulation sectors. She is a member of the Bradenton, Fla., local chapter.
Medicare Benefit Policy Manual, 100-3, ch. 15, sec160.7, Electrical Nerve Stimulators: