Wiki vagus nerve stimulator

[freespririt0806]

hi
were are having denial issues billing vagus nerve surgery for dx G47.33 stating lcd for medical necessity, does anyone have any guidance on this?

CPT code 64582 - Open implantation of hypoglossal nerve neurostimulator array, pulse generator and distal respiratory sensor electrode or electrode array.
CPT code 64568 - Incision for implantation of cranial nerve (eg: vagus nerve) neurostimulator electrode array and pulse generator.

 

[dbrasier4473]

For Medicare you might need to have Documentation to bill BMI code. as secondary diagnosis. You can look up the LCD for specifics on medical necessity for your area.

 

[freespririt0806]

thank you, we do bill BMI and it is still denied..??

 

[cgaston]

Could your patients have any of the contraindications that would cause this to be considered "not medically reasonable and necessary" according to the LCD:

Hypoglossal nerve neurostimulation is considered not medically reasonable and necessary when any of the following contraindications are present:

• Beneficiaries with central and mixed apneas that make up more than one-quarter of the total AHI.
• Beneficiaries with an implantable device could experience unintended interaction with the HGNS implant system.
• BMI equal to or greater than 35
• Neuromuscular disease
• Hypoglossal-nerve palsy
• Severe restrictive or obstructive pulmonary disease
• Moderate-to-severe pulmonary arterial hypertension
• Severe valvular heart disease
• New York Heart Association class III or IV heart failure
• Recent myocardial infarction or severe cardiac arrhythmias (within the past 6 months)
• Persistent uncontrolled hypertension despite medication use
• An active, serious mental illness that reduces the ability to carry out Activities of Daily Living (ADLs) and would interfere with the patient's ability to operate the HNS and report problems to the attending provider.
• Coexisting nonrespiratory sleep disorders that would confound functional sleep assessment
• Beneficiaries who are, or who plan to become pregnant.
• Beneficiaries who require Magnetic resonance imaging (MRI) with model 3024.
• Beneficiaries, who require Magnetic resonance imaging (MRI) with model 3028, can undergo MRI on the head and extremities if certain conditions and precautions are met. Please refer to the Manufacturer Guidelines for this model and future models for more information.
• Beneficiaries who are unable or do not have the necessary assistance to operate the sleep remote.
• Beneficiaries with any condition or procedure that has compromised neurological control of the upper airway.

 

[freespririt0806]

Could your patients have any of the contraindications that would cause this to be considered "not medically reasonable and necessary" according to the LCD:

Hypoglossal nerve neurostimulation is considered not medically reasonable and necessary when any of the following contraindications are present:

• Beneficiaries with central and mixed apneas that make up more than one-quarter of the total AHI.
• Beneficiaries with an implantable device could experience unintended interaction with the HGNS implant system.
• BMI equal to or greater than 35
• Neuromuscular disease
• Hypoglossal-nerve palsy
• Severe restrictive or obstructive pulmonary disease
• Moderate-to-severe pulmonary arterial hypertension
• Severe valvular heart disease
• New York Heart Association class III or IV heart failure
• Recent myocardial infarction or severe cardiac arrhythmias (within the past 6 months)
• Persistent uncontrolled hypertension despite medication use
• An active, serious mental illness that reduces the ability to carry out Activities of Daily Living (ADLs) and would interfere with the patient's ability to operate the HNS and report problems to the attending provider.
• Coexisting nonrespiratory sleep disorders that would confound functional sleep assessment
• Beneficiaries who are, or who plan to become pregnant.
• Beneficiaries who require Magnetic resonance imaging (MRI) with model 3024.
• Beneficiaries, who require Magnetic resonance imaging (MRI) with model 3028, can undergo MRI on the head and extremities if certain conditions and precautions are met. Please refer to the Manufacturer Guidelines for this model and future models for more information.
• Beneficiaries who are unable or do not have the necessary assistance to operate the sleep remote.
• Beneficiaries with any condition or procedure that has compromised neurological control of the upper airway.

thank you this is helpful