Learn What’s New for Neurostimulation

CPT® changes help you report these procedures more accurately.

For 2011, the American Medical Association (AMA) made some notable changes in the Nervous System section of the CPT® code book. CPT® 2011 adds four new codes describing procedures related to peripheral nerve neurostimulation, deletes one related code, revises another, and updates parenthetical information to assist code selection and application.

Added Code Reports Stimulation for Urge Incontinence

New this year is CPT® code 64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming.

Posterior tibial neurostimulation (PTNS) is a minimally-invasive procedure that stimulates the sacral nerve plexus by way of the tibial nerve, to treat urge incontinence (the sacral nerves play an important role in regulating bladder control). A needle electrode is placed through the skin adjacent to the tibial nerve near the ankle to deliver stimulation intermittently for approximately 30 minutes. Treatment may include several sessions; 64566 describes a single session, and includes programming of the device.

A new parenthetical CPT® instruction specifies that you should not report 64566 with 64555 Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve) or 95970-95972 (electronic analysis of implanted neurostimulator pulse generator system).

Cranial Stimulation Gains Several Codes

Three codes are added to describe procedures related to cranial nerve stimulation. The first of these, 64568 Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator, reports incision for implantation of the electrode array and pulse generator.

In previous years, this procedure was reported using component codes that separately described, for instance, the incision (64573) and insertion (61885 Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single elect rode array) of the pulse generator. For 2011, all services are combined in the single code 64568, and the incision for implantation code 65473 is deleted.

CPT® instructs you not to report 64568 with 61885, 61886 Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays, or new code 64570 Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator (discussed below).

Surgeons sometimes must revise and/or replace the electrode array for a cranial neurostimulator. The pulse generator must be revised at the same time for connection to the new electrode array. Because this requires greater effort than placing the electrodes/generator for the first time, a dedicated code (64569 Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator) has been added to report the procedure.

Do not report 64569 with 64570 or 61888 Revision or removal of cranial neurostimulator pulse generator or receiver. For revision or replacement of pulse generator (rather than electrode array) only, report 61885.

If the electrode and pulse generator both are removed without replacement, report new code 64570. Do not report 64570 in addition to 61888 for revision/removal of the pulse generator or receiver; the revision/removal is bundled into 64750.

To better understand how to code implantation, revision/replacement, and removal of the various components of the cranial neurostimulation system, refer to the easy coding chart shown in Table A.

Table A. Cranial Nerve Neurostimulation Easy Coding Chart

Insertion Only Revision Complete Removal
Pulse Generator Only 61885 61888 61888
Generator and Array 64568 64569 64570

For example, a surgeon implants a vagus nerve (cranial nerve X) neurostimulator electrode array and pulse generator. Report this using 64568, which describes the incision and placement of both components. Sometime later, the surgeon must replace the electrode array. Report this using 64569 (This also includes the necessary revision of the generator to accommodate the new electrode array connections.). At a still later date, the entire system (pulse generator and array) is removed. Removal of all components is reported using 64570.

64575 Becomes a “Parent”

Code 64575 Incision for implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve) has been revised so that it is no longer a “child” of (now deleted) code 64573. Instead, 64575 becomes a parent code to 64577 Incision for implantation of neurostimulator electrodes; autonomic nerve, 64580 Incision for implantation of neurostimulator electrodes; neuromuscular, and 64581 Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement). Code use does not vary from previous years, and 64575 still reports incision for implantation of electrode array for stimulation of peripheral nerves other than the sacral nerve.

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G.J. Verhovshek, MA, CPC, is director of editorial development/managing editor at AAPC.

 

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