Neurosurgery Coding Alert

Question: Our physician inserted a bone healing stimulator. How should we report this service?


Washington, D.C., Subscriber


Answer: Medicare and most third-party payers recommend that you report 20975 (Electrical stimulation to aid bone healing; invasive [operative]) when the orthopedic surgeon inserts an internal bone stimulator to aid healing.

Physicians often insert stimulators following procedures such as spinal fusion (22612, Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]).

Most insurers only cover the internal stimulator for nonunion of long bone fractures, and as an adjunct to spinal fusion surgery.

Most payers accept ICD-9 code 733.82 (Nonunion of fracture [pseudoarthrosis] [bone]) when the physician inserts internal or external bone stimulators.

If the surgeon applies an external bone stimulator, report 20974 (Electrical stimulation to aid bone healing; noninvasive [nonoperative]).

Payers will generally cover an external bone stimulator for nonunion of long bone fractures; for failed fusion, when a minimum of nine months has elapsed since the last surgery; for congenital pseudoarthroses; and as an adjunct to spinal fusion surgery for patients at high risk of pseudoarthrosis due to previously failed fusion at the same site or for those undergoing multiple-level fusion.