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Question: The surgeon inserted a skull-mounted cranial neurostimulator pulse generator in a patient with vascular Parkinsonism. The surgeon incises the skull at the implant point, then performs a craniotomy. They then implant the generator and use a tunneling tool under the patient鈥檚 scalp to make room for the leads, which they connect to the implant site. The surgeon then connects the leads to the generator. Finally, the surgeon performs a test simulation to make sure the generator is working properly, and then closes up the patient鈥檚 skull.

Can I report the craniotomy separately from the pulse generator implant? Also, is the revision/removal of the generator separately reportable when the time comes?

Missouri Subscriber

Answer: You cannot report the craniotomy separately in this instance. Craniotomy, or craniectomy, is included in the code you鈥檒l report for the claim: 61889 (Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s)). Also, don鈥檛 forget to append G21.4 (Vascular parkinsonism) to 61889 to represent the patient鈥檚 illness.

You can, however, report revision/removal separately if/when they occur. If the surgeon revises or replaces the pulse generator, report 61891 (Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s)). When the surgeon removes the pulse generator, report 61892 (Removal of skull-mounted cranial neurostimulator pulse generator or receiver with cranioplasty, when performed).

New(ish) code alert 1: If you have CPT^庐 resources that are more than a year old, you aren鈥檛 likely to find 61889, 61891, or 61892, as they were added to the code book in 2024. These additions provide more detail to the codes 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver) code set.

New(ish) code alert 2: The 61889 through 61892 code additions weren鈥檛 the only new cranial device insertion codes in 2024. CPT^庐 also added these codes last year:

• 64596 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array)
• 64597 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (List separately in addition to code for primary procedure))
• 64598 (Revision or removal of neurostimulator electrode array, peripheral nerve, with integrated neurostimulator)

Chris Boucher, MS, CPC, Senior Development Editor, AAPC