# Peripheral Nerve Stimulation electrode



## 574coding (Jul 28, 2016)

Hi,
We have had a issue with Medicare taking back money due to 64555.  We were told they have a outside company (ZAP? )  that has audited and they are requesting the money back.  We were told that providers of acupuncture were using this code and paid incorrectly.  We were told by ZAP that we should use a category III code 0282T, but that does not support the procedure we are dong. 

Anyone else dealing with this?  What have or are you doing?  SO far, we have appealed, but no response yet and they have started the take backs.
Thanks


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## dwaldman (Jul 28, 2016)

Need to confirm if this supports 64555. Is there a specific peripheral nerve in which is receiving the stimulation. If this is in the spinal region and it is area or field of pain that is being targeted then you need to report the category III codes. If the physician is targeting a specific peripheral nerve then you need to point out the specific nerve represented in the operative report which the lead is being placed at and point out peripheral subcutaneous field stimulation differs from what the physician is doing  by addressing the description from AMA CPT Changes 2012 that describes how peripheral nerve stimulation and peripheral subcutaneous field stimulation are separate techniques with separate codes and what is being performed represents the codes you are reporting and the reason it is not PSFS:

"Electrode leads are placed in subcutaneous tissue around the painful area, and electrical current is applied to create stimulation in the area, or "field," of pain. This technique is different from peripheral nerve stimulation, in which specific peripheral nerves are targeted. In peripheral field stimulation, a field of pain is targeted rather than specific nerves. "


 Below is from AMA CPT Changes 2012


 0282T  Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial, including removal at the conclusion of trial period


0283T  permanent, with implantation of a pulse generator 

0284T  Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed


0285T  Electronic analysis of implanted peripheral subcutaneous field stimulation pulse generator, with reprogramming when performed

 (Do not report 0282T - 0285T in conjunction with 64550 - 64595, 77002, 77003, 95970 - 95973)



 Four Category III codes have been established for reporting peripheral field stimulation. Peripheral field stimulation is a new technology for the treatment of chronic cervical, thoracic, or lumbar pain. Electrode leads are placed in subcutaneous tissue around the painful area, and electrical current is applied to create stimulation in the area, or "field," of pain. This technique is different from peripheral nerve stimulation, in which specific peripheral nerves are targeted. In peripheral field stimulation, a field of pain is targeted rather than specific nerves. The electrodes are placed in the skin either through an open or percutaneous approach. Imaging guidance is included, when performed.

 Code 0282T describes implantation of trial electrode arrays and includes removal of the electrodes at the end of the trial period. Code 0283T is reported for permanent implantation of electrode arrays with implantation of a pulse generator. Revision or removal of the pulse generator or electrodes is reported with code 0284T and includes addition of new electrodes, when performed. Code 0285T describes electronic analysis of the pulse generator and includes reprogramming, when performed. An exclusionary parenthetical note precludes the reporting of codes 0282T - 0285T with the peripheral nerve neurostimulator codes 64550 - 64595, fluoroscopic guidance codes 77002 and 77003, or electronic analysis of neurostimulator pulse generator codes 95970 - 97973.

Clinical Example (0282T)

 A 66-year-old male who previously underwent a lumbar discectomy presents with chronic low back pain without radiculopathy. He has no lower extremity symptoms. He denies any bowel or bladder symptoms. Physical examination reveals no neurological abnormalities but lumbar spine range of motion is restricted by pain. He complains of low back pain upon palpation at approximately L3, L4, and L5 bilateral paraspinal muscles. Plain film radiographs of the lumbar spine demonstrated degenerative disc disease and spondylosis at multiple levels. Lumbar spine MRI demonstrates multilevel disc bulges and mild multilevel facet hypertrophy. Despite treatment with physical therapy, nonsteroidal anti-inflammatory medications, opiate therapy, facet joint steroid injections, and epidural steroid injections, no improvement in pain or function was obtained. Due to the patient's failure with conservative treatments and his persistent complaints of diffuse low back pain, a trial of peripheral field stimulation is indicated to attempt to relieve patient's pain and improve function.

 Description of Procedure (0282T)

 Prior to sedation, the area of pain is carefully outlined and patient receives preoperative intravenous antibiotics. Under sterile conditions, with minimal sedation and appropriate monitoring, a needle is placed subcutaneously, using a small amount of lidocaine at the insertion point. Subcutaneous electrode leads are placed centrally in the area of greatest pain. On-the-table stimulation ensures the correct depth of the leads and adequate stimulation over the area of pain. The leads are then sutured to the skin and dressing is applied. Average trial duration is five to seven days.

 Clinical Example (0283T)

 A 66-year-old male who previously underwent lumbar discectomy presents with chronic low back pain without radiculopathy. He has no lower extremity symptoms. He denies any bowel or bladder symptoms. Physical examination reveals no neurological abnormalities but lumbar spine range of motion is restricted by pain. He complains of low back pain upon palpation at approximately L3, L4, and L5 bilateral paraspinal muscles. Plain film radiographs of the lumbar spine demonstrated degenerative disc disease and spondylosis at multiple levels. Lumbar spine MRI demonstrates multilevel disc bulges and mild multilevel facet hypertrophy. Despite treatment with physical therapy, nonsteroidal anti-inflammatory medications, opiate therapy, facet joint steroid injections, and epidural steroid injections, no improvement in pain or function was obtained. Due to the patient's failure with conservative treatments and his persistent complaints of diffuse low back pain, he had undergone a trial of peripheral field stimulation and received significant relief during the trial. Permanent placement of a peripheral field stimulator is indicated.

 Description of Procedure (0283T)

 Prior to sedation, the area of pain is carefully outlined and patient receives preoperative intravenous antibiotics. Under sterile conditions, with minimal sedation and appropriate monitoring, a needle is placed subcutaneously, using a small amount of lidocaine at the insertion point. Subcutaneous electrode leads are placed centrally in the area of greatest pain and in the same region as the trial electrode leads had been placed. On-the-table stimulation ensures the correct depth of the leads and adequate stimulation over the area of pain. The leads are then sutured to the fascia. The pulse generator or receiver is then implanted by a separate incision by establishing a subcutaneous pocket. The electrode array is tested to verify proper connection and the device is programmed to begin stimulation. The wound is closed and dressing is applied.

 Clinical Example (0284T)

 A 66-year-old male presents with an implanted peripheral field stimulator for pain control, which initially provided good coverage and control of pain in the affected area. Over time, the stimulator no longer provided coverage to the affected area and removal of the electrode array and generator is indicated.

 Description of Procedure (0284T)

 Prior to sedation, the area of pain is carefully outlined and patient receives preoperative intravenous antibiotics. Under sterile conditions, with minimal sedation and appropriate monitoring, the old skin incision of the generator is reopened and the wound checked for hemostasis. The old generator is dissected out of its subcutaneous pocket and delivered onto a sterile towel. The lead terminals are carefully disconnected from the expired generator. The subcutaneous pocket is then irrigated and closed. Dressing is applied. The anchoring site of the previous stimulator lead is localized and the overlying soft tissue structures are anesthetized. An incision is made to expose the leads. The lead is cut at the site and removed via gentle traction. The incision is closed and dressing is applied.

 Clinical Example (0285T)

 A 66-year-old male has undergone implantation of a peripheral field stimulator for pain control of his low back pain. Analysis and programming of the pulse generator to correctly address the region of his pain is indicated.

 Description of Procedure (0285T)

 Electronic analysis and programming of an implanted permanent single array electrode system and subcutaneous generator/transmitter is performed. The physician tests a limited combination of the implant parameters while assessing the degree of symptom and side effect improvement or worsening after each programming change.


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