Neurology & Pain Management Coding Alert

Tip: Focus on the components in each descriptor.

Your options for reporting neurostimulator systems to treat central sleep apnea will explode in 2016, with CPT^® adding 13 new Category III code options. Share these descriptors with your neurologists now so they’ll be sure to document all the details you’ll need to report the service accurately.

Pay Attention to Inserted Components

The new codes apply to phrenic nerve stimulation systems. These systems include a pulse generator, one stimulation lead (or electrode), and one sensing lead. Your first step in coding the system’s placement will lie in knowing which components your provider inserts.

Your options will be:

• 0424T – Insertion or replacement of neurostimulator system for treatment of central sleep apnea; complete system (transvenous placement of right or left stimulation lead, sensing lead, implantable pulse generator)

• 0425T – … sensing lead only

• 0426T – … stimulation lead only 

• 0427T – … pulse generator only.

Because each code descriptor refers to either the entire system or a single component, you should only report one code for the procedure. Codes 0425T, 0426T, and 0427T should not be reported with 0424T. That’s because they each represent a portion of what 0424T covers.

Fewer components: What if the physician replaces two of the components, such as both leads but not the pulse generator? Only time will tell. “We can’t be certain how to handle this situation until we see the NCCI edits or we get more information from CPT^®,” says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver, Co. 

Focus on Leads for the 3 Rs

Approximately half of the newly introduced codes apply to removal, replacement, or repositioning of the system.

The same code structure for insertion applies when the physician removes the system:

• 0428T – Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only 

• 0429T – … sensing lead only 

• 0430T – … stimulation lead only.

If the surgeon removes the entire system, CPT^® directs you to submit 0428T for the pulse generator, plus 0429T or 0430T for each transvenous lead removal. If you’re reporting only lead removal, submit 0429T or 0430T once for each lead.

You’ll find a single code for removal and replacement: 0431T (Removal and replacement of neurostimulator system for treatment of central sleep apnea, pulse generator only). When you report removal and replacement of the entire system, you’ll file with 0424T, 0428T, 0429T, and 0430T.

“This is unusual,” Hammer notes. “The other Category I neurostimulator codes typically direct that you not report the removal and replacement codes together.”

Sometimes the provider needs to reposition a lead in order to better target the patient’s phrenic nerve. “The repositioning usually is performed when the neurostimulator lead can’t capture the necessary stimulation site(s),” says Hammer. In that case, base your coding on the affected lead:

• 0432T – Repositioning of neurostimulator system for treatment of central sleep apnea; stimulation lead only 

• 0433T – … sensing lead only.

You can file both codes if the physician repositions both leads. Remember you’re reporting repositioning, not replacement. Therefore, you cannot report 0432T or 0433T with any of the codes for insertion or replacement (0424T-0427T).

Evaluate Your Options for Evaluation

The final three codes of interest pertain to the evaluation of an interrogation or programming device:

• 0434T – Interrogation device evaluation implanted neurostimulator pulse generator system for central sleep apnea 

• 0435T – Programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea; single session 

• 0436T – … during sleep study.

You cannot report the evaluation codes with any of the other new codes related to the system’s insertion, removal, or replacement. Also note that 0435T and 0436T are not reportable together since the provider won’t be evaluating the system during both a single session and a sleep study.

Your final guideline for these codes is to submit 0436T only once per sleep study.

The codes were released by the CPT^® Editorial Panel on July 1, 2015, and will be implemented Jan. 1, 2016. They’ll first appear in your CPT^® book in 2017.