Wiki Interstim..I don't understand it!

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alp.jeffrey

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I know Interstim has been addressed so many times within this forum but my little brain just can't grasp the concept. I'm very new to billing these and obviously I'm not doing it right due to claims not getting paid.

For instance, I have one that is billed:
64561
64590
95972
76000
Insurance is denying 95972 and 76000 as being bundled to 64561 and 64590.
OP note says "full implant" so from the info I've looked it, the 64561 and 64590 are correct. But why is the 95972 being bundled. I did see where imaging is included in the 64561 so should I drop 76000?
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And then just making sure...I have one that says "stage 1" which from what I've read isn't really a thing anymore. So it's placement of leads (64561), programming (95972), fluoroscopy (76000). But then he has listed "No battery." I'm so confused. So would this mean that the neurostimulator implant was not put in but just the leads and I'd just bill the 64561??

"The lead was brought into this pocket. Next a trocar was used to advanced through the pocket more cephalad and medial still in the right portion of the body in a subcutaneous fashion. The trocar was more broad and an incision was made over the cephalad portion until the trocar could be advanced through the skin. The edge of the trocar was exchanged for a pocket where a external lead plastic compartment could be fitted which was done so and then brought back into the pocket on the right hemibuttock. The trocar was removed and the lead was cleaned off of any blood and advanced into the plastic lead holder and collected in with 1 click on with the small screwdriver."

Sorry that this is so lengthy. I just really want to get this right.
 
Hello, I'd remove CPT 76000. Since 64561 has imaging mention in the description.
I'd apply modifier 59 to CPT 76000, as this is allowed with 64590 only. And to make it clear your applying it to 64590.
 
From my experience, different physicians will perform this procedure in different ways. Some do temporary leads first in the office, then take the patient to OR for full implant. Others will do it all at once. I have found some good references on AUGS website. Just be aware there were some changes (maybe 2022??) so if the reference is older, just make sure the advice given is still correct. With the information you supplied, it seems ONLY leads were placed, so 64561 only. Please note 64561 should be billed with -LT, -RT or -50 if bilateral. The documentation supplied doesn't state anything about programming (95972) or imaging (which would be included in 64561 anyway). A pocket is mentioned which would typically indicate the generator/receiver being placed (64590), but documentation is not clear to me.
I would suggest reading some of the below references to get a better understanding of interstim in general, and then query the provider if there is not any other documentation.
Amazing references (designed for patients) about urogyn in general: https://www.augs.org/patient-fact-sheets/
 
64561 is the percutaneous placement of the electrode array (leads) [If an open placement is done, use 64581]
76000 cannot be used with 64561 as the CPT description includes image guidance

64590 is the implantation of the generator and connection to the implanted leads

95970- Electronic analysis without programing is inherent and cannot be reported with any implantation codes
95971 and 95972 can be reported if performed by surgeon or other qualified health care professional. If performed by device rep, it cannot be reported.

Full system implant (array and generator/receiver): CPT codes 64561 and 64590 (and 95972 if programming by surgeon).



64561 - Percutaneous implantation of neurostimulator electrode array, sacral nerve (transforaminal placement) including image guidance if performed
Temporary Lead implantation
-Because the definition of code 64561 includes image guidance, use of fluoroscopy is inherent and cannot be coded separately. NCCI edits prohibit use of fluoroscopy codes with 64561
-In 2022, the definition of 64581 was revised to say “open” to clarify that it involves surgical exposure of the sacrum, previously required to suture permanent sacral leads in place. 64561 should be used for all leads placed percutaneously without surgically exposing the sacrum, regardless of whether they are tined or untined leads, or test or permanent leads. CPT Assistant, October 2021, p.7.
-Stage I

64590 -Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver
-Generator Implantation (or replacement)
-Stage II
 
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