Neurosurgery Coding Alert

Question: Our surgeon's operative report reads "bilateral 4-lead subcutaneous Medtronic field stimulators with battery insertion ......" We billed 64555 (Percutaneous implantation of neurostimulator electrode array; peripheral nerve [excludes sacral nerve]) x4. Medicare denied payment stating that number of units exceeded acceptable maximum. Can you please explain how we can bill this again?

New Jersey Subscriber

Answer: There is insufficient information provided to offer specific guidance. For example, does "4 lead" mean four contacts on one neurostimuilator electrode array or does it refer to four arrays? Are you treating four different peripheral nerves or the same nerve at multiple locations? CMS payment rules can limit the number of units of any particular service. Some of these limits were developed with the medically unlikely edits (MUE) process. If separate nerves have been treated with one neurostimulator array for each nerve, the 59 (Distinct procedural service) modifier may be applicable.