How To Use CPT Code 63650

CPT 63650 involves the percutaneous implantation of a neurostimulator electrode array in the epidural space to alleviate pain and reduce spasms. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 63650.

1. What is CPT 63650?

CPT 63650 is a medical procedure code that refers to the percutaneous implantation of a neurostimulator electrode array in the epidural space. This procedure is performed to help relieve pain and reduce or eliminate spasms in patients suffering from chronic pain or other neurological conditions.

2. 63650 CPT code description

The official description of CPT code 63650 is: “Percutaneous implantation of neurostimulator electrode array, epidural.”

3. Procedure

The 63650 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. The provider advances a needle into the epidural space, under fluoroscopic guidance.
3. A percutaneous electrode is guided through the needle up to the mid-thoracic spine.
4. An external stimulator is attached to the other free end of the electrode.
5. The provider checks for different combinations between the electrodes and the leads until the stimulator generates paresthesias that the patient feels.
6. The external unit is detached, and the impedance in the leads is checked.
7. The leads are attached to the skin.

4. Qualifying circumstances

Patients eligible to receive CPT code 63650 services are those who suffer from chronic pain or other neurological conditions that have not responded to conservative treatments such as medications, physical therapy, or other non-invasive interventions. The procedure is typically recommended for patients with conditions such as failed back surgery syndrome, complex regional pain syndrome, or intractable angina.

5. When to use CPT code 63650

It is appropriate to bill the 63650 CPT code when a provider performs the percutaneous implantation of a neurostimulator electrode array in the epidural space to alleviate pain and reduce spasms in a patient who has not responded to conservative treatments. The procedure should be considered as a last resort when other non-invasive interventions have failed to provide relief.

6. Documentation requirements

To support a claim for CPT 63650, the following information needs to be documented:

• Patient’s medical history and previous treatments for pain management.
• Physical examination findings and any diagnostic tests performed to determine the cause of the pain.
• A detailed description of the procedure, including the use of fluoroscopic guidance and the placement of the electrode array in the epidural space.
• Post-procedure assessment, including the patient’s response to the stimulation and any complications or adverse events.
• Follow-up care plan, including any additional treatments or interventions required.

7. Billing guidelines

When billing for CPT code 63650, it is essential to follow the specific guidelines and rules set forth by the payer. Some tips and codes that apply to CPT code 63650 include:

• Ensure that the patient’s medical record contains all the necessary documentation to support the claim, as outlined in the documentation requirements section.
• Use the appropriate modifiers, if necessary, to indicate any special circumstances related to the procedure.
• Be aware of any payer-specific rules or policies regarding the coverage and reimbursement of CPT code 63650.

8. Historical information

CPT 63650 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 63650

Five similar codes to CPT 63650 and how they differentiate from CPT 63650 are:

• CPT 63655: Involves a laminectomy for the implantation of neurostimulator electrodes, plate, or paddle in the epidural space, rather than a percutaneous approach.
• CPT 63661: Refers to the removal of a spinal neurostimulator electrode percutaneous array.
• CPT 63662: Involves the removal of a spinal neurostimulator electrode plate or paddle array.
• CPT 63663: Refers to the revision of a spinal neurostimulator electrode percutaneous array.
• CPT 63664: Involves the revision of a spinal neurostimulator electrode plate or paddle array.

10. Examples

Here are 10 detailed examples of CPT code 63650 procedures:

1. A patient with failed back surgery syndrome undergoes percutaneous implantation of a neurostimulator electrode array in the epidural space to alleviate chronic pain.
2. A patient with complex regional pain syndrome receives a percutaneous implantation of a neurostimulator electrode array in the epidural space to reduce pain and spasms.
3. A patient with intractable angina undergoes percutaneous implantation of a neurostimulator electrode array in the epidural space to manage pain.
4. A patient with chronic neuropathic pain receives a percutaneous implantation of a neurostimulator electrode array in the epidural space after conservative treatments have failed.
5. A patient with spinal cord injury-related pain undergoes percutaneous implantation of a neurostimulator electrode array in the epidural space to improve pain management.
6. A patient with phantom limb pain receives a percutaneous implantation of a neurostimulator electrode array in the epidural space to alleviate pain.
7. A patient with refractory migraine headaches undergoes percutaneous implantation of a neurostimulator electrode array in the epidural space to reduce the frequency and intensity of migraines.
8. A patient with chronic pelvic pain receives a percutaneous implantation of a neurostimulator electrode array in the epidural space to manage pain.
9. A patient with postherpetic neuralgia undergoes percutaneous implantation of a neurostimulator electrode array in the epidural space to alleviate pain.
10. A patient with trigeminal neuralgia receives a percutaneous implantation of a neurostimulator electrode array in the epidural space to reduce pain and spasms.