Neurology & Pain Management Coding Alert

Knowing about other types of neurostim gets you ready to code

When a patient needs neurostimulation treatment, the physician's options fall into three categories, depending on which part of the nervous system he treats (peripheral, sympathetic or central). Most of these cases center on spinal cord stimulation (involving the central nervous system), but you should also be prepared to code other neurostimulation treatments your physician might consider.

Watch for TENS, PENS Peripheral Options

The peripheral nervous system carries impulses from the brain and spinal cord to nerve endings throughout the body. Three common ways neurologists treat peripheral pain include:

- Transcutaneous electrical nerve stimulation (TENS): TENS is a noninvasive technique in which the physician attaches a stimulator to the skin over the peripheral nerve being treated, says Darlene Isom, billing supervisor in the anesthesia department of Northwestern Medical Faculty Foundation Inc. in Chicago. Report TENS with 64550 (Application of surface [transcutaneous] neurostimulator).

- Percutaneous electrical nerve stimulation (PENS): With this procedure, the physician inserts a needle electrode through the patient's skin to stimulate the peripheral nerves. Report PENS with 63650 (Percutaneous implantation of neurostimulator electrode array, epidural).

- Implanted peripheral nerve stimulator: The physician implants electrodes around a selected peripheral nerve. Then he uses a lead to connect the stimulating electrode to a receiver unit implanted just under the skin.

The physician uses an external generator to -talk- to the internal receiver unit to deliver pain medication as needed. Physicians use implanted stimulators to treat pain in the patient's sciatic or ulnar nerves, says David Walega, MD, of the Anesthesiology Pain Medicine Center at NMFF.
 
The physician places this stimulator either percutaneously (under the skin) or via an incision. Report 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) for percutaneous placement or 64575 (Incision for implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) for incisional implantation.

Remember Electrode Implantations

The sympathetic nervous system controls automatic muscle actions, such as your heartbeat.

Physicians sometimes implant electrically stimulated electrodes in the carotid sinus to relieve a patient's pain from angina pectoris (413.9, Other and unspecified angina pectoris).

Pain specialists perform these procedures most often, but some neurology groups include physicians who place electrode implants. If that's the case in your group, code the electrode placements as 64560 (Percutaneous implantation of neurostimulator electrodes; autonomic nerve) or 64577 (Incision for implantation of neurostimulator electrodes; autonomicnerve), depending on the placement approach.

Note: For more information on coding for spinal cord stimulators, see -Match Diagnosis With Neurostimulation Codes- in the November 2006 Neurology Coding Alert.