Neurology & Pain Management Coding Alert

Question: Our pain management specialist percutaneously implanted four trial subcutaneous leads in the lumbar spinal region and reported four units of 64555. The payer denied the claim, but I'm confused because a February 2010 coding tip in CPT® Assistant advised to bill per lead. What's the correct coding?

New Hampshire Subscriber

Answer: Effective January 1, 2012, there are new Category III codes specifically for reporting percutaneous implantation of subcutaneous field neurostimulators. These are typically used in the treatment of cervical, thoracic, or lumbar pain with the leads inserted in the subcutaneous tissue around the painful area. The neurostimulation targets the "field" of pain rather than a specific individual peripheral nerve such as the greater occipital or ulnar nerve.

The code to report for percutaneous placement of trial subcutaneous field neurostimulator arrays (leads) is 0282T (Percutaneous or open implantation of neurostimulator electrode array[s], subcutaneous [peripheral subcutaneous field stimulation], including imaging guidance, when performed, cervical, thoracic or lumbar; for trial. Including removal at the conclusion of trial period).

This code is reported with a maximum of one unit of service as it represents implantation of one or more array(s) / lead(s). The coding is different from spinal cord or peripheral nerve neurostimulator array / lead implantation which is based on each individual lead. Also changed is that there is a separate code for permanent implantation -- 0283T (Percutaneous or open implantation of neurostimulator electrode array[s], subcutaneous [peripheral subcutaneous field stimulation], including imaging guidance, when performed, cervical, thoracic or lumbar; permanent, with implantation of a pulse generator) versus the 0282T Category III code for trial lead placement.