# Coding Permanent Neurostimulators



## kfrycpc (Mar 24, 2015)

Hi all,

I really need help with this.   We don't do alot of these and they are a little different each time so it's a little hard to really wrap my head around it.  A patient had a *permanent *neurostimulator put in yesterday.  This is how I coded it:

64555
64590
95972  
L8680 x 2   as the report says 16 leads.  

The payer is a workers comp. I think the above is correct but what confuses me is should there be a 64555 and 64590?

Thanks in advance,
Kellie


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## dwaldman (Mar 25, 2015)

Is this a dorsal column stimulator (63650 63685) or peripheral nerve stimulator (64555 64590)?

Is there documentation  more than 3 parameters programmed personally performed by the physician. Typically the manufacturer's representative does the programming and it is not separately reportable with CPT 95972.

L8680 Implantable neurostimulator electrode, each 

The above HCPCS code is reported per electrode. You would need to know how many leads were placed and how many electrodes were on the each lead to capture the number of units. If you 2 leads were placed with 8 electrodes on each lead then it would give the 16 electrodes total. But you only listed CPT 64555 once which only corresponds to one lead being placed.


You asked about:
64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling

I think the first think you have to determine if this is a peripheral nerve stimulator and if a specific nerve being treated versus peripheral subcutaneous field stimulation which falls under Category III codes.

CPT 64590 would represent that Internal pulse generator was placed for peripheral nerve stimulator. I noticed there is not an associated L code for this device in your post.


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## KMCFADYEN (Apr 3, 2015)

I have all of the same questions and more.  
I code for several pain management groups.  
Are you doing the permanent placement in the office or a facility?  

My groups do the trial in the office where we bill for the leads (L8680) either times 8 or 16 for all insurance with the exception of Medicare (CMS has bundled the leads in with the lead placement CPT as of 1/1/15).  For the trial, you only code for the lead placement and the leads themselves.

They then do the permanent placement in a facility setting so we do not bill for the leads as the ASC or hospital would supply and bill for them.  For the permanent placement in the facility, you would only bill for the lead placement and the pulse generator insertion.


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## kfrycpc (Apr 3, 2015)

KMCFADYEN said:


> I have all of the same questions and more.
> I code for several pain management groups.
> Are you doing the permanent placement in the office or a facility?


Facility


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