Anesthesia Coding Alert

Neurostimulation treatments depend on which part of the nervous system the physician treats. In addition to spinal cord stimulation (which involves the central nervous system), pain management physicians also perform other types of neurostimulation treatments to the peripheral and sympathetic nervous systems.

The peripheral nervous system carries impulses from the brain and spinal cord to nerve endings throughout the body. Three common ways to treat peripheral pain are:

Transcutaneous electrical nerve stimulation (TENS) - This is a noninvasive technique in which the physician attaches a stimulator to the skin over the peripheral nerve to be treated. Report 64550 (Application of surface [transcutaneous] neurostimulator) for TENS.

Percutaneous electrical nerve stimulation (PENS) - During PENS, the physician inserts a needle electrode through the patient's skin to stimulate the nerves. Use 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for PENS.

Implanted peripheral nerve stimulator - The  physician uses an external generator to "talk" to an internal receiver unit to deliver pain medication as needed. Many patients use implanted stimulators to treat pain in the sciatic or ulnar nerves. Report 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) for percutaneous stimulator placement or 64575 (Incision for implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) for incisional implantation. The sympathetic nervous system controls automatic muscle actions, such as your heartbeat. Report these electrode placements with 64560 (Percutaneous implantation of neurostimulator electrodes; autonomic nerve) or 64577 (Incision for implantation of neurostimulator electrodes; autonomic nerve), depending on the placement approach.