Coding New Territory

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Most of us are quite comfortable with the coding aspects of our individual practices. Every now and again, though, unusual circumstances may lead to unique opportunities, a call to rise above and beyond or perhaps just sheer desperation. Perhaps your partners are out of town and you are stuck doing (and coding for) cases you have not seen since residency (and never coded for). Perhaps the diagnosis, approach or technology you are faced with is novel or rare.  How do you know you are coding correctly if you are implanting the first dorsal root ganglion stimulator in the state, or maybe in the country? Today, we review what coding resources and strategies are available when you are coding within new territory.

The Napoleonic wars changed our world in ways we cannot imagine and in ways we have forgotten or have taken for granted. It took the unusual combination of federal period nationalism and a near-bankrupt Napoleon for the Louisiana Purchase to occur in 1803. Rare opportunity led to massive territorial expansion and a need to accurately chart and map the new territory. So, how would Meriwether Lewis and William Clark have answered our questions regarding coding for dorsal root ganglion stimulator implantation or the skull base approach you may have seen a couple of times as a resident? One of two strategies may have been suggested:

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1. The first is the Sacagawea approach: Seek out the help of someone familiar with the lay of the land or the surgeries you are trying to code. What is uncharted territory for you might be home to someone else, and what might be an unintelligible tongue for you might be easily interpreted by your institution’s coding and compliance officer or Medicare liaison. In the case of the dorsal root ganglion stimulator, you may not find someone at your institution with enough familiarity to help you accurately code.

2. You may not have a clear idea of what language needs interpretation. In a situation like this, Lewis and Clark might dust off Captain Cook’s “A Voyage to the Pacific Ocean,” to find clues from a similar (but not identical) undertaking. In our case, we would need to dust off the codes for percutaneous implantation of a spinal cord stimulator percutaneous implantation of neurostimulator leads 63650 x number of leads, programming of neurostimulator, up to an hour 95972 and implantation of neurostimulator pulse generator 63685.

At this point, we have studied a similar course, which would take us through territory unfamiliar to most neurosurgeons, but one that our interventional pain or neuromodulation colleagues might serve as our Sacagawea. An inquiry with the North American Neuromodulation Society would yield confirmation that the CPT codes for implantation of dorsal root ganglion stimulator are identical to implantation of percutaneous spinal cord stimulator. Our journey is done.

In conclusion, for coding uncharted territory seek assistance: Lewis and Clark could not have done it alone. Consult your institution’s coding and compliance team or Medicare liaison. Seek out the assistance of subspecialty societies or practitioners who are more familiar with the procedure. Most importantly though, never compromise patient safety. If you are not familiar with how to place a dorsal root ganglion stimulator, refer the patient to a neuromodulation center.

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