Table of Contents

Basics of CPT code 63650

Spinal cord (dorsal column) stimulation (SCS) is a pain relief technique that delivers a low-voltage electrical current to the spinal cord to block the sensation of pain. This technique is best suited for pain that is neuropathic in nature i.e., resulting from actual damage to the peripheral nerves. In medical coding, we have separate codes for reporting these procedures like CPT code 63650,63655,63661 etc. Common indications for such pain include, failed back syndrome, complex regional pain syndrome, arachnoiditis, radiculopathies, phantom limb/stump pain, peripheral neuropathy.

CPT code 63650 with code description

63650 Percutaneous implantation of neurostimulator electrode array, epidural

63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

63661 Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed

63662 Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy,
when performed

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

63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver

HCPCS code L8680 (Implantable neurostimulator electrode, each)

Covered medical necessity ICD 10 code for CPT code 63650

B02.0 Zoster encephalitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.29 Other postherpetic nervous system involvement
G03.0-G03.1 Meningitis due to other and unspecified causes
G03.8-G03.9 Meningitis due to other and unspecified causes
G54.0-G54.1 Nerve root and plexus disorders
G54.6-G54.7 Nerve root and plexus disorders
G56.40-G56.43 Causalgia of upper limb
G56.80-G56.93 Other specified mononeuropathies of unspecified upper limb – Unspecified mononeuropathy of left upper
limb
G57.70-G57.73 Causalgia of lower limb
G57.80-G57.83 Other specified mononeuropathies of lower limb
G57.90-G57.93 Unspecified mononeuropathy of lower limb
G90.511-G90.529 Complex regional pain syndrome I (CRPS I)
G90.59 Complex regional pain syndrome I of other specified site
I70.221-I70.229 Atherosclerosis of native arteries of extremities with rest pain
M51.14-M51.17 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with radiculopathy
M54.11-M54.13 Radiculopathy, occipito-atlanto-axial region, cervical region, cervicothoracic region
M54.14-M54.17 Radiculopathy, thoracic region, thoracolumbar region, lumbar region

Sample Coded report for CPT 63650

PROCEDURES PERFORMEDPROCEDURES PERFORMED

Cervical spinal cord stimulator permanent placement

Revision of the previous lumbar internal generator

DIAGNOSES

Cervical postlaminectomy syndrome

Chronic pain

ANESTHESIA: Monitored anesthetic care

ESTIMATED BLOOD LOSS: 5 cc

FINDINGS: Appropriate stimulation patterns were obtained in postop holding. The patient received 2 g of Ancef prior to incision.

PROCEDURE IN DETAIL: The patient was identified in the preop holding area. She again consented for the procedure and demonstrated clear understanding of what we were going to do. She denied any recent cough, cold, fevers, or chills. The patient was advised that we were going to remove her current lPG and replace it with a new 4-lead system. This had all been discussed in the office, and no further changes were made today.The patient was then transported to the operating room and placed on the OR table with assistance of the staff. Proper positioning was confirmed and then the patient was given adequate sedation to tolerate the procedure. The neck through the right gluteal area were then prepped and draped in the normal sterile fashion. C-arm was utilized to identify the T3-T4 interspace and the area over the midline was anesthetized with approximately 15 mL of a half and half mixture of 1% lidocaine with epi and 0.5% Marcaine. The skin over the midline was then incised, and electrocautery was used to dissect down to the fascial plane.Hemostasis was obtained. We then used a 14-gauge Epimed Coude needle to access the T3-T4 interspace using a low oblique approach and loss of resistance to a combination of saline and air. Once the epidural space was accessed, a percutaneous spinal cord stimulator lead was introduced and was guided up to the right C2 vertebral body. This movement was observed under live fluoroscopy as well as intermittent AP and lateral still shots to ensure proper placement and location. The process was then repeated on the left, and once both leads were in place, the patient was allowed to awaken to ensure proper stimulation patterns. After initial testing, some slight modifications were made, and the patient then described complete coverage of her normal pain patterns.The patient was then re-sedated, and the needles were removed ensuring no significant change of the lead placement. The leads were then secured to the fascia using the Boston Scientific Clik Lock anchors, again using frequent visualization under fluoroscopy to ensure no lead movement. The skin over the implanted generator was then anesthetized with 10 mL of the same solution as before as well as an area on the right of midline in the lumbar spine that was also anesthetized to allow for an extension to be placed. The old generator was then explanted and the new generator was hooked up. We reconfirmed appropriate impedances from the lumbar leads. Once this was confirmed, we tunneled from the mid-thoracic incision site to the lumbar incision site. We then connected extensions, tested impedances, and completed tunneling all the way down to the lPG location. Once the system was completely hooked up, it was tested for proper impedances, and after that was confirmed, the new lPG was placed into the existing pocket.All incision sites were then copiously irrigated and suctioned and dried. They were then closed with a 2-0 Vicryl deep stitch. Again, hemostasis was ensured and then the skin was closed with staples. The dressing was a bacitracin ointment covered by 4 x 4s and a Tegaderm.The patient was then transported to the recovery area, where she underwent further education and programming from Boston Scientific. Initial report is appropriate stimulation patterns. The patient will be seen in the clinic for followup in approximately 1 week and staples will be removed in 7 to 10 days.Please assign the correct CPT codes for the procedure above.

ANSWERS

CPT Code 63650 Percutaneous implantation of neurostimulator electrode array, epidural

CPT code 63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling