Neurosurgery Coding Alert

Answer:

Internal Bone Stimulators. You should not use 62351 (implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy) for a bone stimulator because it is for implantation of a drug pump catheter via a laminectomy. It is unlikely that a neurosurgeon would perform a laminectomy for the purpose of implanting a bone stimulator. The code Medicare and most third-party payers recommend is 20975 (electrical stimulation to aid bone healing; invasive), and it is never used alone. A fusion such as 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) is usually performed at the same time.

The internal stimulator is only covered for nonunion of long bone fractures, and as an adjunct to spinal fusion surgery, etc. Nonunion of long bone fractures, for both invasive and noninvasive devices, is considered to exist when serial radiographs have confirmed that fracture healing has ceased for three or more months prior to starting treatment with the stimulator. Serial radiographs must include a minimum of two sets, each having multiple views of the fracture site, separated by a minimum of 90 days. ICD-9 code 733.82 (nonunion of fracture [pseudoarthrosis] [bone]) is the most commonly accepted diagnosis associated with internal or external bone stimulators.

Follow-up for the internal bone stimulator would be included in the 90-day global period of the fusion code.

External Bone Stimulators. Code 20974 (electrical stimulation to aid bone healing; noninvasive) should be used for the placement of an external bone stimulator. Medicare considers that there is insufficient evidence to support the medical necessity of using a stimulator for treating nonunions of the skull, vertebrae or those that are tumor-related. In addition, Medicare will not cover ultrasound stimulation for fresh fractures. Coverage guidelines for Medicare may be different from the coverage criteria of many private insurers. Check with your local carriers for more details.

An external bone stimulator is usually only covered for nonunion of long bone fractures; failed fusion, when a minimum of nine months has elapsed since the last surgery; congenital pseudarthroses; and as an adjunct to spinal fusion surgery for patients at high risk of pseudoarthrosis due to previously failed fusion at the same site or for those undergoing multiple-level fusion.

Follow-up for an external bone stimulator would usually be covered during office visits (99211-99215).

Purchased or Leased? The actual stimulator is usually purchased by the hospital, and unless an approval was given by the payer to buy and bill the internal device, you should probably leave it to the hospital.

An external stimulator is typically leased as DME (durable medical equipment) by the patient from the manufacturer. If you are dispensing them to the patient out of your office, they are typically billed under HCPCS E0747 (osteogenesis stimulator, electrical, nonivasive, other than spinal applications) or E0748 (... spinal applications) as a flat-fee lease.