C1778 - neurostim lead (trial)
C1897 - neurostim lead (implant)
C1767 - generator (non-rechargeable)
C1820 - generator (re-chargeable)
Medicare does have LCD requirements for this procedure. If conditions are not present or not documented, and therefore not coded, we will be denied payment for these services.
SPINAL STIMULATOR OR LEADS:
For these CPT codes:
63650 Implant neuroelectrodes
63655 Implant neuroelectrodes via laminectomy
63685 Insertion or replacement spine neuro generator
Medicare requires the patient chronic pain for the procedures above to be considered medically necessary. Any of the following conditions are covered under this policy:
Chronic pain due to trauma
Other chronic postoperative pain
Neoplasm related pain (acute) (chronic)
Chronic pain syndrome
Medicare requires one of the following reasons for the chronic pain to be listed for the above procedures to be considered medically necessary. Any of the following conditions are considered covered under this policy:
Post herpetic trigeminal neuralgia
Herpes zoster; with other nervous system complications
Meningitis
Reflex sympathetic dystrophy, specify site
Nerve root and plexus disorders, specify site
Causalgia of upper limb, specify site
Mononeuritis of upper limb and mononeuritis multiplex, specify site
Causalgia of lower limb, specify site
Mononeuritis of lower limb, specify site
Atherosclerosis of the extremities with rest pain
Postlaminectomy syndrome, specify site
Brachial neuritis or radiculitis, specify site
Other and unspecified disorders of back, specify disorder
Spinal cord injury without evidence of spinal bone injury, specify site
BLADDER STIMULATOR AND LEADS:
For these CPT Codes:
64561 Percutaneous implant neurostim electrodes, sacral nerve
64581 Incisional implant neurostim electrodes, sacral nerve
64585 Revision of peripheral neurostimulator electrodes
64590 Insert or replace peripheral neurostimulator generator
64595 Revision or removal of peripheral neurostimularo gen
A4290 Sacral Nerve stimulation test lead, each
Medicare requires one of the following reasons to be listed for the above procedures to be considered medically necessary. Any of the following conditions are considered covered under this policy.
Low Bladder compliance
Detrusor sphincter dyssndergia
Retention of urine
Urinary incontinence
Urinary hesitancy
Functional urinary incontinence
Other symptoms involving urinary system, specify
I am not a certified coder. I am in the process of becoming certified but have been billing these for a few years. Hope this helps.