Wiki Cpt 64575

[mattrobin]

Our Dr's occassionally implant permanent peripheral stimulators. When they do this, I have not been coding 64575. I was recently told that we can bill this code, if it's documented in the reprot. However, what is an example of what it needs to say for me to know to use this code? Can they just say "incision performed".. or "cut down".. any ideas/ help would be great. Thanks

 

[dwaldman]

Lay Descriptions from Ingenix's Encoder

64555
The physician places an electrode percutaneously (through the skin) through an introducer needle into the tissue to be stimulated. Electrodes placed over sensory nerves decrease pain sensation in the distribution of the nerve. Electrodes placed over motor nerves stimulate paralyzed muscles to prevent atrophy.

64575
The physician makes an incision to place the electrode. The physician uses a scalpel to incise the skin and dissects the to the anatomical location. The incision aides the physician in accurately placing and testing the electrode while visualizing results. After stimulating the area, the incision is closed with layered sutures. Electrodes placed over sensory nerves decrease pain sensation in the distribution of the nerve. Electrodes placed over motor nerves stimulate paralyzed muscles to prevent atrophy.

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There is a minor surgical incision when placing and securing permanent percutaneous peripheral leads----This does not constitute billing 64575. If the physician performs a lot these procedures. I would send a portion of the procedure note to the AMA CPT Network to see if they feel it meets the intent of 64555 versus 64575. With the lack of published information from the AMA on these codes, the room for interpretation is broad and the cost of the inquiry would be worth it.