# P-Stim



## LivvyLou06 (Jul 22, 2014)

My office is being pestered by a rep for P-Stim; I do not agree with what they recommend we bill for the P-Stim. This is coming from their reimbursement specialist:

64553 or 64555 ? you would never bill these together

I sometimes am asked about the word ?implantable? as a problem with using the 64553 or 64555 codes discussed below.  The device is not implantable; the electrodes are.  Often, when ?implantable? is discussed, there is an incision being made and a ?pocket? made to insert a neurostimulator generator pack into.  However, I have found no guidance that this must be the case.  I, and many others that I have consulted with, consider the needles of the device to be the electrodes and the electrodes are percutaneously implanted directly into certain nerves in the nerve bundles within the ear.  The code definition says ?percutaneous implantation of neurostimulator electrodes?, which is what you are doing when placing the device.  This is why I believe the codes are appropriate.

64555 ? Percutaneous implantation of neurostimulator electrodes; peripheral nerve ? It is important to note that this code has a 10 day global period.  The day of placement is not counted.  This means that the global period goes through day 11 and the procedure cannot be billed again until the 12th day.  Payers will typically pay this code only one time during the global period.  
Can this code ever be billed for a subsequent procedure during the global period?  Yes.  However, your documentation must clearly show that you plan ?x? number of staged procedures and that additional procedures (staged) will be done during the global period.  IF your documentation clearly states this, you can use Modifier -58 (staged procedure) when the procedure is done a second time within the global period.  When you use Modifier -58, a new global period begins.  

If your documentation does not address that a second procedure will be done within the global period, you should not use Modifier -58 and the global period does apply.  Your office will need to make sure your documentation shows your intent to conduct a staged procedure within the global period OR your office will have to determine how you will bill the payers or the patients if you are using a protocol that requires subsequent neurostimulators to be placed before the 12th day but your documentation does not reflect staged procedures.  If you are using a protocol of placing subsequent neurostimulators within this global period but your documentation does not support this, you would not bill the procedure (see example below).  
Note:  When the procedure is performed in an ASC or outpatient hospital center, the facility will bill this procedure code, and the doctor will bill the professional component of this code using a ?PC Modifier 
OR  
64553 ? Percutaneous implantation of neurostimulator electrodes; cranial nerve ? Note:  This code has a much more narrow set of appropriate diagnoses (see Diagnoses Chart).  Most doctors tell me that they are seldom targeting a cranial nerve. As with the above code, this code has a 10 day global period and the above information applies. 

L8680 ? Implantable neurostimulator electrode (with any number of contact points), each.  This code can be billed for each electrode, which means it could be billed three times per procedure, when using this device, if the doctor implants all three electrodes. Typically this should be shown as one line item with three units, not as three separate line items, unless the payer requests you to bill this differently.
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The research I have done leads me to believe the best way to code is 64999 with supporting documentation. I would just like some further insight on this; I have read older posts regarding this that confirm my suspicions but perhaps now that you can see what the reps are saying exactly that may help too.
They have told us _not_ to tell the insurance company that the device we are billing is called a P-Stim because they will deny it. Instead we are to tell the insurance company that we are performing a percutaneous implantation of electrodes. I don't agree with that at all nor do I feel comfortable with it. 

Any help and insight is appreciated!


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## dwaldman (Jul 22, 2014)

The AMA has suggested by a published article in CPT Assistant from February 2014 that CPT 64999 is the appropriate code selection for this type of procedure. There is not any published material stating that it is acceptable to bill a peripheral nerve stimulator code for the procedure.

AMA CPT Assistant February 2014 page 11

Frequently Asked Questions:Surgery: Nervous System

Question: May CPT code 64999, Unlisted procedure, nervous system, be used to report implantation of the P-STIM device for pain management? 

Answer: Yes. CPT code 64999, Unlisted procedure, nervous system, would be used to report P-STIM procedures and services. Reporting for unlisted procedures and services must be documented to include information such as the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the procedure or service.


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## KMCFADYEN (Jul 23, 2014)

I agree with dwaldman.  
One of our pain docs was pestered by a rep earlier this year trying to get him to do the P-Stim with those codes.  I told him the reps were incorrect as to how to bill it (he thought he'd be able to make a big profit like the SCS trials) so we were able to persuade him not to do it.


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## LivvyLou06 (Aug 5, 2014)

Awesome, thank you both!


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