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Billing Question in regards to the Percutaneous Stimulator

  1. #1
    Nashville Tennessee Chapter
    Default Billing Question in regards to the Percutaneous Stimulator
    Medical Coding Books
    I have a question in regards to the billing for a Percutaneous Stimulator (for a trial). We are interested in starting them for our office, but are being advised by a Drug rep to bill out what seems to be way to high and too good to be true reimbursement. Our office plans to bill out for the leads that go with the percutaneous stimulator as well.

    This is what we are being told to bill:
    64555- Percutaneous implantation 1 unit to bill.
    L8680- Implantable neurostimulator electrode each. 16 units to bill (since billed per electrode).

    The description of procedure for us is: Placement of peripheral nerve stimulator lead times two. (which would equal the 16 electrodes since each lead has 8).

    I had been advised at one point to bill out the 63650 instead of the 64555 and not bill out for the leads (L8680), but I am not sure that this is correct either.

    Reimbursement on this seems very be high since we are doing this in our office and almost seems to good to be true. I want to make sure before we accept and start billing for a lot of these, that we do not get into trouble for the codes being billed. Drug reps tend to make the deal sound better than what it truly is for business so I'm a bit skeptical.

    I hope that you will be able to have better insight on this than I do. Your time and help in this matter is greatly appreciated.

    Last edited by jwhitten; 03-17-2010 at 11:54 AM.

  2. #2
    Typically when our practice and/or facility bills for spinal stimulator trials we bill for 63650 only.

  3. #3
    Nashville Tennessee Chapter
    Does your practice purchase the supplies (i.e. leads and electrodes) for this procedure? Ours does which is why we have been advised to bill out the L8680.

  4. #4
    North Carolina
    We also use 63650 for percutaneous (Trial) implantation of a spinal neurostimulator. The electrode array is placed in the epidural space of the spine. For 64555, the physician places an electrode under the skin to stimulate nerve tissue; in this particulcar case (64555), peripheral nerves.

    Below is a vignette of 63650:

    The patient is positioned in the operating room. X-ray fluoroscopy (C-arm) is used to identify the target epidural location for the electrode array and the interlaminar space for the array to enter the epidural space. Local anesthesia, perhaps with intravenous sedation, is given.

    A needle is placed through the skin so that the needle tip enters the spinal epidural space at the target interlaminar space. Through this needle is passed the catheter that contains the electrode array so that the catheter goes into the epidural space. The array is maneuvered in the space until it is positioned at the target epidural location, as shown by x-ray. Any sedation is allowed to reverse at this point. The electrode contacts are then positioned in the spinal epidural space to provide stimulation to block the area of the patient's chronic pain.

    After placement of the electrode array, the tail of the device is anchored to the skin or underlying fascia/ligaments. This is then connected to either an internal or external stimulator generator or receiver to provide the actual electrical stimulation to the spinal epidural space.

  5. #5
    Nashville Tennessee Chapter
    This procedure will be placed on the peripheral nerve in the skin but not in the epidural space of the spine.

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