Precise Coding Key for Spinal Cord Stimulation Reimbursement
Published on Sat Jan 01, 2000
Surgical insertion of spinal cord neurostimulators for pain management is a complicated related/staged surgical procedure that many insurance company payers do not understand. Consequently, reimbursement for this procedure may be decreased dramatically by carriers who bundle what should be individual codes or strike what they believe to be duplicate billing. But by learning Medicares guidelines for the procedure and educating insurance carriers about them, neurosurgeons can ensure proper reimbursement.
Rhonda Petruziello, CPC, a neurosurgery reimbursement specialist who works with the Cleveland Clinic Foundation in Cleveland, says neurosurgeons can educate their carriers about this procedure by providing them with a procedural analysis, showing them exactly what is involved.
1. Coding the Insertion of Spinal Cord Stimulators
The introduction of a spinal cord stimulator for pain reduction into a patient is a two-stage process requiring surgery to two separate and distinct areas of the body. Depending on the patients response during the first stage, both surgeries may be performed on the same day within hours of one another, or they may be performed on different days.
First, the neurosurgeon must gauge the potential effectiveness of the neural stimulation. This is the screening/trial stage. Either electrical leads will be inserted with a needle into the spine or a surgical incision will be made to allow the introduction of a plate or paddle. If the electrical leads are employed, the physician should bill 63650 (epidural percutaneous implantation of the neural stimulator electrodes). For the plate/paddle, bill 63655 (laminectomy for implantation of epidural neurostimulator electrodes, plate/paddle).
2. Billing for Test Itself
Once the method for testing has been introduced, the actual test must be performed. The temporary electrode is hooked to an external power supply, a remote control used by the patient to increase or decrease stimulation levels, and a monitoring device for analysis and programming of the system.
The patient gives verbal feedback to verify if he or she feels paresthesia or tingling over the pain area. Additionally, several other electronic tests are performed on the system. If the patient feels the tingling and the additional tests show that no programming is required, this first set of tests has been successfully executed and the neurosurgeon may bill code 95970 (electronic analysis of the implant stimulator pulse generator system, e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance, and patient compliance measurements; simple or complex neurostimulator pulse generator without reprogramming).
If the patient does not feel the requisite tingling and tests show that reprogramming of the stimulator is required, code 95972 (complex brain or spinal cord neurostimulator pulse generator/transmitter, with intraoperative subsequent programming, first hour). If this procedure takes more than one hour, use 95973 (complex [...]
