Neurology & Pain Management Coding Alert

When a chart for neurostimulation treatment crosses your desk, get the full story before coding the case. Physicians try a range of treatments before advising neurostimulation (also called spinal cord stimulation, or SCS), so verifying the patient's diagnosis and previous treatments helps justify your neurologist's service.

Neurostimulation patients typically have a variety of pain conditions. These can include chronic radiculopathy (729.2, Neuralgia, neuritis and radiculitis, unspecified), sciatica (724.3), reflex sympathetic dystrophy (337.2x), postherpetic neuralgia (053.13, Postherpetic polyneuropathy), or vascular insufficiency (such as 443.9, Peripheral vascular disease, unspecified).

Narrow the choices: Several criteria help your physician determine whether neurostimulation is a viable option for the patient, including:

- More conservative therapies (such as over-the-counter or prescription medications, trigger point or facet injections, physical therapy or corrective surgery) have failed to adequately relieve the pain. -SCS is a treatment typically recommended when all other means of treating or eliminating pain have either been ineffective or have side effects that interfere with the patient's quality of life,- says Darlene Isom, a billing supervisor at Northwestern Medical Faculty Foundation Inc. in Chicago.

- Nerve conduction studies or other tests pinpoint the pain's origin, and the physician diagnoses the cause of pain.

- The patient's condition does not warrant further traditional surgery to treat the pain.

- No medical issues (such as diabetes, drug abuse or misuse, or susceptibility to infection) exist that would present problems during surgery.

- The patient successfully passes physical and psychological evaluations. The neurologist should always obtain a psychological consultation before any stimulation trial, Isom says, to ensure there are no unresolved issues such as severe depression to interfere with the patient's long-term benefit.

- The screening test and trial succeed. Double-check that the physician implants a dorsal column, permanently implanted stimulator. -There are other types of stimulation treatments, so be sure that you-re coding for implanting a dorsal column stimulator instead of one of the other therapies,- Isom says.

Neurostimulation uses tiny electrical impulses to keep nerves from transmitting pain messages to the brain. Some patients experience total pain relief after neurostimulation, while others may feel a mild tingling sensation instead of pain. Either result improves the patient's quality of life.