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Coding for Neurostimulator Trial

  1. Default Coding for Neurostimulator Trial
    Medical Coding Books
    Hello Group,

    My Doctor have done a Trial for N-Stimulator for chronic pain(back), occipital neuralgia, and cervical radiculopathy, in a surgery centre.

    Electrodes were primarily placed in occipital regions along the occpital nerve for the neuralgia with ANS electrodes,followed by placement of electrodes along the cervical nerve as well, under fluoroscopic guidance followed by the electronic analysis and programming.

    How does one go abt coding it?

    What can be the payment scenario if the primary Trial fails and a Re-Trial is done? What is the Trial period?
    Dr. Somit Hazra, CPC.

  2. Smile
    We have recently started doing Spinal Cord Stimulators and Peripheral Nerve Stimulators in our office. I have found that the staff at St. Jude Medical (formerly ANS) are very helpful. The toll free # is (800)727-7846.

    I have not perfected the coding yet, therefore I will refrain from giving you my opinion on your question. Give them a call and they will most certainly be able to help you. Good Luck and Happy Holidays!

  3. Smile
    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.


    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
    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

    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.

  4. Question Scs
    wondering what coding scenario would be for instance where revision on permanent scs done w/ in 90 day global, both leads were replaced due to displacement.I was thinking 63650-78, 63650-59,78 and 63660. I code for an ASC.

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