Coding Spinal Neurostimulator-Trial (temporary) vs Permanent

 Spinal Neurostimulator: Removal, Insertion, Replacement, and Analysis (CPT codes 63650, 63655, 63661-63664)

CPT Assistant April 2011, Volume 21, Issue 4, page 10

Question:

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.