Need help coding this Spinal Cord Stimulator procedure
I am having trouble coding a SCS procedure as I do not typically code these and I am hoping that there is someone on this list-serve that is knowledgeable in this area and would be willing to help me.
* A 2-lead spinal cord stimulator percutaneous implant.
* Implantable pulse generator (PG batter) implant with assistance. Intraoperative programming and analysis complex.
* Intraoperative fluoroscopy with interpretation.
After the patient was properly anesthetized and prepped and draped in the usual fashion the T12-L1 interspace was located bilaterally, 14-gaughe Tuohy needles were inserted from first the left and then the right side using a standard loss of resistance technique. Next, the medtronic subcompact lead was placed on one side and a compaq trial lead on the other side. It was easily navigated to the epidural space and up to the previous successful trial site, which was the very top of the T7 vertebral body at the 6-7 disk space. The leads were placed slightly higher to program in the middle and sort of at the top of the lead as in trial, so that the leads were covering T6 and T7 in entirety in a staggered fashion. Device was programmed and analyzed in a sterile fashion with the aid of the medtronic rep and found to be in excellent working order with good reproduction of the patients typical pain pattern reported while prone. At that point, the sedation was deepened and copious skin anesthesia was provided at the surgical sites and once the patient was resting comfortably the skin between the incisions was cut down to the fascia. The needles were exposed and removed. The leads were tied down to the fasica with 0 silk, 2 to 3 ties bilaterally using the medtronic titanium anchors. Tension release was applied by loop and then attention was turned to the battery site that previously had been anesthetized and previously been marked with the patient. It was cut down approximately 2cm deep. A pocket was created with a combination of blunt, sharp and bovie dissection. The incision was copiously irrigated. The battery was placed. It was analyzed through the skin with the aid for the company rep and found to be in perfect working order with normal impedance at 16 contacts.
1. I'm not sure if the coding should be 63650x1 or 63650x2 and 63685 and whether a 51 modifier is necessary.
2. Fluoro is not reportable since it is not documented, but what if it had been documented? Is it separately reportable?
3. I'm not sure whether 95971 or 95972 is the correct code or whether it is separately billable since it appears to be a normal part of the procedure.
4. L8680? I know nothing about these codes or when they are appropriate.
Would the coding differ based on Medicare or third party payer?