L8680: Don’t Allow Confusion to Affect Neurostimulator Coding
Review the facts to ensure appropriate reporting and payer reimbursement.
By Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO
Code descriptors are supposed to help coders and billers report procedures, services, and supplies more accurately—but that’s not always how it works out. Consider medical device code L8680 Implantable neurostimulator electrode, each, for example. Over the past two years, the descriptor for this HCPCS Level II code has been a source of confusion. A review of the facts, however, will ensure that you are reporting L8680 accurately, and that payers are reimbursing you appropriately.
Anatomy of Confusion: A Review of L8680
For 2009 dates of service, the long and short descriptors for HCPCS Level II L8680 specified, “Implantable neurostimulator electrode, each.” In November 2009, the Centers for Medicare & Medicaid Services (CMS) released the 2010 Alpha-Numeric HCPCS file, which included a revised long descriptor “Implantable neurostimulator electrode (with any number of contact points), each.” The short descriptor for L8680 was not revised.
The revised long descriptor created confusion due to the ambiguity of the term “electrode.” Did CMS intend one unit of L8680 to represent a single electrode? Or, did one unit of service apply to an entire lead, made up of several electrodes? The latter interpretation differed from previous practice, and affected reimbursement dramatically.
To understand why the definition of “electrode” matters so much, you need to review the basics of a neurostimulator device relative to L8680. Neurostimulators consist of a power source (pulse generator or receiver) to deliver electrical stimulation and one or more electrode array(s) or lead(s). Some systems also use an extension wire as a connection between the lead and power source. The terms “array” and “lead” frequently are used interchangeably.
A neurostimulator array typically contains multiple (usually four to eight) electrodes. From a technical perspective, electrode and contact point are synonymous terms; each electrode equals a single contact point. For example, there are four electrodes or contact points on a single quadripolar array.
In 2009, L8680 was coded and billed per electrode—that is, per each contact point. For example, one array with four electrodes (contact points) would be billed L8680 x 4 units of service. The release of the 2010 HCPCS Level II code descriptor revision raised the question, “Did CMS intend for providers to report the revised HCPCS Level II code with one unit of service (based on the descriptor change `with any number of contact points’)? Or, did CMS intend providers to continue billing L8680 based on the total number of electrodes?”
Members of both physician specialty organizations and medical device manufacturers made multiple inquiries to CMS requesting clarification regarding the revised HCPCS Level II code descriptor and compliant coding.
CMS Restores the 2009 Descriptor
On Dec. 18, 2009, CMS announced that, effective Jan. 1, 2010, it would revert to the 2009 long descriptor for L8680. The code descriptor would remain the same as it was for 2009 dates of service, with one unit of service defined as one electrode or contact point. CMS concurrently released the 2010 HCPCS Level II correction file that included “Implantable neurostimulator electrode, each” long and short descriptors for L8680.
Unfortunately, the change came too late to be included in the published 2010 HCPCS Level II code books. Because non-Medicare payers may update their HCPCS Level II code files only annually (and, as such, could have implemented the wrong code descriptor for L8680), physician practices had to be diligent in reviewing their 2010 payer explanation of benefits to ensure that L8680 was correctly paid.
2011 May Not End the Confusion
The publication of 2011 HCPCS Level II, with a correct descriptor for L8680, should have spelled an end to the confusion over how to apply the code. Unfortunately, an unspecified number of 2011 HCPCS Level II codebooks were published with the invalid 2010 descriptor, which included “any number of contact points,” instead of the correct code descriptor for L8680, “Implantable neurostimulator electrode, each.”
As a result, payers and providers alike may continue to believe, incorrectly, that a single unit of L8680 represents an implantable electrode array with any number of contacts. In fact, correct coding and reimbursement requires a single unit of L8680 for each implanted electrode (contact point). For example, two arrays (leads) with eight electrodes (contact points) each would be coded compliantly as L8680 x 16 units of service (2 x 8 = 16 contact points).
Not only should providers make certain they are billing the medical device implant correctly, they also should review their explanation of benefits for L8680 claims to ensure those claims were processed and paid correctly.
Take Away Tips
Here are some additional points to keep in mind when reporting neurostimulator lead/electrode medical device implants:
- L8680 is used to report the total number of implanted electrodes (contact points) in a physician office setting.
- L8680 may be used by hospitals and ambulatory surgical centers (ASCs) for reporting outpatient services to non-Medicare payers (be sure to verify individual payer policies/contracts).
- Outpatient hospitals must use C codes when reporting devices to Medicare. In a hospital outpatient setting, a neurostimulator lead is reported using C1778 Lead, neurostimulator (implantable). This HCPCS Level II code is reported and reimbursed per lead (array), rather than per electrode (contact point).
- Medicare does not allow separate payment for implanted neurostimulator devices in an ASC. Rather, the surgical procedure codes are considered to be device-intensive procedures and, as such, reimbursement for the implants is included in the payment for the surgical procedure.
Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, with MJH Consulting, works in a consulting capacity with manufacturers such as Boston Scientific Corp. to ensure appropriate research and due diligence on coding questions and related assistance.