“Too expensive” may be one of your least favorite phrases—and you can avoid it with some sharp-shooter coding. If you often work with advanced procedural coding, you know how expensive many of these procedures can be. When it comes to botulinum toxins, intrathecal drug delivery, and spinal cord stimulation (SCS), one small mistake could cost your practice hundreds of dollars.
Don’t let coding for chronic pain therapies turn into a source of chronic pain for you. By knowing a few key words to look for in the operative notes, says coding consultant Amy Turner, you can quickly turn this into a pain-free process. In her ProfEdOnDemand presentation on advanced procedural coding, part of a four-part series for the 2019 Coding Updates Virtual Boot Camp, Turner presents common clinical scenarios and 2019 updates to set coders off on the right foot for the new year.
SCS: When the Stimulator Malfunctions
As Turner mentions in her presentation, a few pain management CPT® codes can easily trip you up. For instance, when coding SCS procedures, be sure you know the specific type performed. There are three main types of SCS procedures: removal, replacement, and revision. Let’s break those down:
SCS involves the implantation of a small device in the body to give electrical impulses to the spinal cord. These impulses mask pain for the patient, thereby helping them better manage chronic pain and decrease the use of or dependence on opioids. The implanted device, surgically inserted under the skin, is designed to last for years, but sometimes the battery dies or the device malfunctions. When this happens, the physician will have to repair the problem.
During a repair, depending on the severity of what happened, the physician has the option to replace, remove completely, or revise.
Code clues: Most revision code definitions read “revision including replacement,” so you don’t have to worry too much about the differences between these two terms. Just remember that replacement is when the entire device was removed and replaced with a completely new device, but revision applies when only the malfunctioning components of the device were removed and replaced.
Most SCS Codes Stay the Same, But 3 Change for 2019
Even if distinguishing among removal, replacement, and revision is relatively straightforward for you, selecting the right corresponding code may not be. Here are the CPT® codes associated with SCS removal, replacement or revision:
Removal (codes include fluoroscopy if performed)
- 63661, Removal of spinal neurostimulator electrode percutaneous array(s).
- 63662, Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy.
Revision and (sometimes) replacement
- 63663, Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed.
- 63664, Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed.
- 63685, Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling.
Revision or Removal
- 63688, Revision or removal of implanted spinal neurostimulator pulse generator or receiver.
More: There are also codes 95970-95973, used to report electronic analysis services, and almost all of them are seeing revisions for 2019. Code 95973 is the lone one in this group staying the same. These codes are seeing definition revisions, with more specific wording added to help you pick the right code. Watch out, though: Lengthy code definitions can easily trip you up, so take time reading through each definition to select the right code.
Quick Tips for Pain Management CPT® Codes
The 2019 CPT® code set implementation date is getting closer every day. January 1, 2019 will be here before you know it. Get started on learning the changes now. Tune in to Turner’s presentations to learn more about how advanced procedural coding and the pain management CPT® codes are changing for 2019, and to learn tricks for navigating the definition changes for 95970-95972. A refresher course or two in November could save your practice hundreds or thousands of dollars in 2019.
Are these all of the CPT code change for Pain management? I am looking for a complete list of changes to shares with our providers.