How To Use CPT Code 63685

CPT 63685 involves the insertion or replacement of a spinal neurostimulator pulse generator or receiver, which is used to decrease pain or replace a malfunctioning component. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 63685.

1. What is CPT 63685?

CPT 63685 is a medical procedure code that refers to the insertion or replacement of a spinal neurostimulator pulse generator or receiver. This device is implanted to help manage chronic pain or replace a malfunctioning component in patients who have already undergone spinal neurostimulation therapy.

2. 63685 CPT code description

The official description of CPT code 63685 is: “Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider incises the skin at the location of the neurostimulator implantation site, usually the abdomen.
3. A subcutaneous pocket is created, or if replacing an already implanted device, the old generator is dissected from the pocket and the leads are disconnected.
4. If replacing the generator, the existing previously implanted leads are attached to the new generator. For an initial implant, the provider subcutaneously passes the leads from the electrode array at the spine using a tunneling device from the back and around the patient’s side to the implanted neurostimulator pulse generator or receiver.
5. The lead or leads are connected to the generator. The leads are separately implanted over an epidural pocket in the spinal cord over the affected vertebra.
6. The generator is secured in the fibrous tissue under the skin, and the incision is closed and covered with a sterile dressing.

4. Qualifying circumstances

Patients eligible to receive CPT code 63685 services are those who suffer from chronic pain that has not responded to conservative treatments, such as medications, physical therapy, or nerve blocks. Additionally, patients who have already undergone spinal neurostimulation therapy and require a replacement of the pulse generator or receiver due to malfunction or end of battery life are also eligible for this procedure.

5. When to use CPT code 63685

It is appropriate to bill the 63685 CPT code when a provider inserts or replaces a spinal neurostimulator pulse generator or receiver in a patient who meets the qualifying circumstances mentioned above. This code should be used for both initial implantations and replacements of the device.

6. Documentation requirements

To support a claim for CPT 63685, the following information should be documented in the patient’s medical record:

• Patient’s medical history and diagnosis, including the chronic pain condition being treated and the conservative treatments that have been tried and failed.
• Indication for the procedure, such as the need for a replacement due to malfunction or end of battery life.
• Details of the procedure, including the type of device used, the location of the implantation site, and the steps taken during the surgery.
• Postoperative care instructions and follow-up appointments.

7. Billing guidelines

When billing for CPT code 63685, it is essential to follow the specific guidelines and rules set forth by the payer. Some tips for billing this code include:

• Ensure that the patient meets the qualifying circumstances for the procedure.
• Document all necessary information in the patient’s medical record to support the claim.
• Do not report CPT 63685 in conjunction with CPT 63688 for the same pulse generator or receiver.

8. Historical information

CPT 63685 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2005, with the previous descriptor being “Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling.”

9. Similar codes to CPT 63685

Five similar codes to CPT 63685 and how they differentiate are:

1. CPT 63650: Involves the percutaneous implantation of a neurostimulator electrode array in the epidural space.
2. CPT 63655: Refers to the laminectomy or laminotomy for the implantation of a neurostimulator electrode array in the epidural space.
3. CPT 63661: Covers the removal of a spinal neurostimulator electrode percutaneously placed.
4. CPT 63662: Involves the removal of a spinal neurostimulator electrode placed via laminotomy or laminectomy.
5. CPT 63688: Refers to the revision or removal of a spinal neurostimulator pulse generator or receiver.

10. Examples

Here are 10 detailed examples of CPT code 63685 procedures:

1. Insertion of a spinal neurostimulator pulse generator in a patient with chronic lower back pain who has failed conservative treatments.
2. Replacement of a spinal neurostimulator pulse generator in a patient with a malfunctioning device causing inconsistent pain relief.
3. Insertion of a spinal neurostimulator receiver in a patient with complex regional pain syndrome who has not responded to other treatments.
4. Replacement of a spinal neurostimulator pulse generator in a patient with a depleted battery, resulting in decreased pain relief.
5. Insertion of a spinal neurostimulator pulse generator in a patient with failed back surgery syndrome and persistent pain.
6. Replacement of a spinal neurostimulator receiver in a patient with a damaged device due to an accident.
7. Insertion of a spinal neurostimulator pulse generator in a patient with chronic neuropathic pain who has not found relief with medications.
8. Replacement of a spinal neurostimulator pulse generator in a patient with a device that has reached the end of its expected lifespan.
9. Insertion of a spinal neurostimulator receiver in a patient with intractable pain due to spinal cord injury.
10. Replacement of a spinal neurostimulator pulse generator in a patient with a device that has been recalled by the manufacturer.