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61850: Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical. This code is used when performing a procedure to create small holes in the skull (twist drill or burr holes) for the placement of neurostimulator electrodes in the cortical region of the brain.
61860: Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical. This code is used when a larger surgical opening (craniectomy or craniotomy) is performed to implant neurostimulator electrodes in the cerebral cortex (outer layer of the brain).
61863: Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site; first array. This code is used for the stereotactic implantation of a neurostimulator electrode array in a subcortical site, such as the thalamus, globus pallidus, subthalamic nucleus, periventricular, or periaqueductal gray. It includes the first array placement without the use of intraoperative microelectrode recording.
61864: Each additional array (List separately in addition to primary procedure). This code is used when additional neurostimulator electrode arrays are implanted during the same procedure as described by code 61863. Each additional array beyond the first is reported using this code.
61867: Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site; first array, with use of intraoperative microelectrode recording. Similar to code 61863, this code is used for the stereotactic implantation of a neurostimulator electrode array in a subcortical site, but it includes the use of intraoperative microelectrode recording during the procedure.
61868: Each additional array (List separately in addition to primary procedure). This code is used when additional neurostimulator electrode arrays are implanted during the same procedure as described by code 61867. Each additional array beyond the first is reported using this code.
61880: Revision or removal of intracranial neurostimulator electrodes. This code is used when revising or removing previously implanted intracranial neurostimulator electrodes.
61885: Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array. This code is used when inserting or replacing a cranial neurostimulator pulse generator or receiver, with the connection to a single electrode array.
61886: Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays. Similar to code 61885, this code is used when inserting or replacing a cranial neurostimulator pulse generator or receiver, but with the connection to two or more electrode arrays.
61888: Revision or removal of cranial neurostimulator pulse generator or receiver. This code is used when revising or removing a previously implanted cranial neurostimulator pulse generator or receiver.
Please note that these explanations are based on the provided information and should be verified with the latest coding guidelines and documentation requirements. For accurate coding and billing practices, it is recommended to refer to the most recent version of the CPT codebook, official coding guidelines, and seek guidance from professional
Scenario: A patient undergoes a craniotomy for the implantation of neurostimulator electrodes in the cerebral cortex.
In this scenario, the relevant CPT codes would be:
61860: Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical. This code would be used to report the craniotomy procedure performed to implant the neurostimulator electrodes in the cerebral cortex.
Additionally, if the procedure involves the placement of multiple electrode arrays, the following codes may apply:
61863: Twist drill, burr hole, craniotomy, or craniotomy with stereotactic implantation of neurostimulator electrode array in subcortical site; first array. This code would be used to report the stereotactic implantation of the first neurostimulator electrode array in a subcortical site, if applicable.
61864: Each additional array (List separately in addition to primary procedure). If more than one additional neurostimulator electrode array is implanted during the same procedure, this code would be used to report each additional array beyond the first.
Therefore, based on the scenario, the coding for this neurostimulator procedure would be:
61860 (Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical)
Copies of my page by page notes you can transfer into your books can be found by clicking link below!
It's important to note that the actual coding may vary depending on the specific details of the procedure, documentation, and any additional factors involved. It is always recommended to review the complete medical record, consult the official coding guidelines, and consider any payer-specific requirements to ensure accurate coding and billing practices.
Please consult the latest version of the CPT codebook and refer to official coding guidelines for accurate coding information.
Certification Exam Scenario:
Answers 1st!
A. 61850
B. 61863
C. 61868
D. 61867
Before looking at a question, go to the answers 1st. Look for the CPT code differences in each answer.
Differences
A. = Cortical
B. = Subcortical
C. = + Add on code = Can not be correct answer
D. = Subcortical
So looking at what our simple one word differences are that we pre prepared prior to the exam (for instructions on how to do this-what any of my Youtube Membership videos on book prep by joining Click Here)
A. = Cortical
B. = Subcortical
C. = + Add on code = Can not be correct answer
D. = Subcortical
Now based off that step, we can see that B & D are most likely the questions purpose, exam makers want to know if you know the differences in these two CPT codes based off looking for Similarities. (A technique I teach for FREE)
So the next step is what are the differences between B & D?
B. = No Recording
D. = Recording.
Now armed with information, we will go skim the question for that difference only. This will be the first time looking at the question!
Operation
A trial of a deep brain stimulator electrode is recommended. The patient is placed in the head holder adapter for the frame. The scalp is incised exposing the skull using a perforator to make a single burr hole 2.5 cm from the midline at the level of the coronal suture exposing the dura and is punctured for access. Microelectrode recording (MER) and stimulation is done to target and reposition the electrodes to determine the best placement for the neurostimulator electrode. The neurostimulator electrode array is placed in the thalamus and fastened into position with radiographic image monitoring placement. The lead is coiled in a pocket under the galea, which is sutured closed, followed by skin closure.
Looking for the key term ONLY from bottom up of the question you will see =
A trial of a deep brain stimulator electrode is recommended. The patient is placed in the head holder adapter for the frame. The scalp is incised exposing the skull using a perforator to make a single burr hole 2.5 cm from the midline at the level of the coronal suture exposing the dura and is punctured for access. Microelectrode recording (MER) and stimulation is done to target and reposition the electrodes to determine the best placement for the neurostimulator electrode. The neurostimulator electrode array is placed in the thalamus and fastened into position with radiographic image monitoring placement. The lead is coiled in a pocket under the galea, which is sutured closed, followed by skin closure.
In the question you will find radiographic image monitoring AKA Recording
Meaning the answer to this question is D. 61867. Code 61867 is the correct code to report the neurostimulator electrode placed in the subcortical site (thalamus) by going through a burr hole using microelectrode recording.
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The US version of ICD-10, created by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), consists of two medical code sets—ICD-10-CM and ICD-10-PCS.