Neurology & Pain Management Coding Alert

You’ll have numerous new Category III codes to begin using in January for phrenic nerve stimulation system procedures to treat central sleep apnea (CSA). But what does this mean?

Your body has two phrenic nerves (left and right). Each originates in the neck and passes down between the lung and heart to reach the diaphragm. These nerves play a pivotal part in breathing because they pass motor information to the diaphragm while receiving sensory information.

Phrenic nerve stimulation, also known as diaphragm pacing, is the electrical stimulation of the phrenic nerve using a surgically implanted device. This device contracts the diaphragm rhythmically, improving breathing function in patients with respiratory insufficiency.

The transmitter and antennas of the phrenic nerve stimulator send radio frequency energy to the implanted receivers. The receivers then convert the radio waves into stimulating pulses. These pulses are then sent down the electrodes to the phrenic nerves, causing the diaphragm to contract. This contraction causes the patient to inhale. When the pulses stop, the diaphragm relaxes and the patient exhales. Repetition of this series of pulses produces a normal breathing pattern.

The condition: Central sleep apnea (CSA) is a condition in which the patient’s breathing repeatedly stops and starts during sleep. It occurs because the brain doesn’t send the proper signals to the muscles that control breathing. Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude also may cause central sleep apnea.

The difference: CSA is different from obstructive sleep apnea, which keeps the patient from breathing normally because of upper airway obstruction. The patient with CSA periodically doesn’t breathe at all, or breathes so shallowly that oxygen intake is ineffectual. In either type of sleep apnea, the lack of oxygen usually causes the patient to wake up, at least briefly.

Treatment of the CSA patient is more challenging because the signal to the body to inhale is not being transmitted from the breathing center in the brain.