A patient was seen at our facility for the removal of an old dorsal column stimulator and replacement of a new stimulation system. According to the operative report, both the generator and the electrodes were successfully removed, but since the new leads could not be placed, the procedure was aborted without any new devices being implanted. We are familiar with the guidelines for reporting the intended procedure with modifier 73/74 for incomplete procedures, but in this case, with separate procedures for implant/removal/replacement, it’s a bit more challenging!
Would it be appropriate to report both of the intended procedure(s) with modifier 74, (63685-74, 63663-74) or to report the spinal stimulator replacement code, 63685, with modifier 74 along with the code for the successful electrode removal (63661), or whether to report the removal of the generator (63688), plus the intended electrode replacement (63663-74), or some other combination of codes. There is another option to consider which would be to report both of the removal codes, 63688 and 63661.
When the first procedure is completed and a second procedure is started but not completed, the second procedure is reported with modifier 74 and no modifier would be appended for the first procedure. In addition, when one or more planned procedures are completed, the completed procedures would be reported. Any other procedure(s) that were planned, and not started, are not reported.
Therefore, report CPT code 63688, Revision or removal of implanted spinal neurostimulator pulse generator or receiver, for the removal of the old dorsal column stimulator system. This code includes the removal of the electrodes. For the attempted placement of the electrodes, report CPT code 63650, Percutaneous implantation of neurostimulator electrode array, epidural. Modifier 74, Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia, would be appended to CPT code 63650 to specify that placement of the electrodes was attempted but not completed. Although the replacement of the spinal generator was planned, it was not started, therefore it is not reported.