Spinal Cord Stimulator Revision

Need assistance on making sure I am coding SCS Revision correctly. I want to know if I should use as primary code 63663 and as 2nd code 63685 on this particular revision. This was appears to be similar like the other revision I posted yesterday. Based on this procedure I was advised elsewhere to actually use 63650 as the primary and then 63688 as the 2nd code, so I am not sure. This is a Medicare patient so I was advised a modifier would not be necessary. Procedure done was:

Removal of Internal Pulse Generator

Implantation of 8 contact SCS lead

Revision of Generator Pocket

Implantation of New Internal Pulse Generator

Use of fluroscopy for radiographic guidance

Interpretation of radiographic pictures

OP Description: Patient was brought to the operating room and was placed in the prone position. The patients skin was prepped and drapped from the midthoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were indentified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthetized with a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicarb. This previous incision was opened using blunt and sharp dissection. The capsule surrounding the internal pulse generator was identified and opened. The generator was dissected out and retention suture was removed. The pulse generator was then removed from the pocket and removed in its entirety. The previous leads were disconnected from the generator. A testing cable was then connected to the previously implnated leads. The pateint was woken from sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. Patient did not receive adequate paresthesias in the lower back as well as the left lowere extremity. Patient was placed back under sedation. Under fluro guidance at the L1/2 level was accessed with a 14ga coude needle using a loss of resistance technique. An additional 8 contact lead was hen advanced through the needle to the level of mid T7 and to the left of midline. Patient was then woken from sedation and tesing again. Patient stated that the stimulation was much better than previous generator and there was better coverage in pain pattern. Patient then elected to have generator changed to the new Boston Scientific precision spectra internal pulse generator. The previous generator pocket was then revised in order to accomadate the new generator. A tunneling tool was used to place the new lead into the new generator pocket. The previously implanted lead and the new lead were then connected to the new generator. The new generator was interrogated. All of the connections were verified and impedances were checked.

Appreciate your help on this request.

lwilcox

Spinal Cord Stimulator Revision