What is the procedure code for the Spinal Cord?
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1833(e) is the title of the Social Security Act.It is against the law for Medicare to pay for claims without the necessary documentation.
The Local Coverage Determination uses the following billing and coding guidance.
Physicians with a low trial to permanent implant ratio (less than 50%) will be subject to post-payment review and may be asked to submit documentation as to the patient selection criteria, the radiologic images demonstrating proper lead placement, and the medical necessity of the trials.Failure to provide this documentation will cause a denial of reimbursement.All patients may not have a good result from the trial implant, but careful selection should find the most appropriate patients.
A repeat trial is not appropriate if there are circumstances that lead to trial failure.On appeal, appropriate medical documentation can be sent.
The clinical record should include the elements leading to the diagnosis and the therapies tried before the decision was made to use spine stimulators.The Correct Coding Initiative may make changes to the code.The policy doesn't take precedence over CCI edits.If the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary.One permanent spinal cord stimulator per patient per lifetime is required in order for code 63650 to be covered more often.
Providers may be able to identify those Bill Types typically used to report this service with the help of contractors.Absence of a Bill type does not mean that the article doesn't apply to it.The article should be assumed to apply equally to all claims if there is no Bill Types.