# Coding for Neurostimulator Trial



## Somit

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?


----------



## shelli0951

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!


----------



## wahalaura

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.


SPINAL STIMULATOR OR LEADS:

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
	Meningitis
	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




BLADDER STIMULATOR AND LEADS:
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.


----------



## paula f3

*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.


----------

