Neurosurgery Coding Alert

Question:

Of the codes 64568 or 64568 and 61885-51, 95974, which one is appropriate to report the implantation of a vagal nerve stimulator? And what are the RVUs for 64568?

Pennsylvania Subscriber

Answer:

Reporting code 64568 (Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator) implies that the surgeon placed the electrode array and the pulse generator. You would code 64569 (Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator) when the surgeon does a revision or replacement of the electrode array and its connections to an existing pulse generator. These codes are new for 2011. Note that code 64568 now includes both placement of the vagus nerve electrode, as well as placement of the pulse generator.

Note that 64568 or 64569 cannot be used with 64570 (Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator) which is reported if the surgeon removes the electrode array and the pulse generator of the stimulator. In addition, 64568 also cannot be used with 61885 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array), 61886 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays), and 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver). Code 64569 being for the electrodes only, can be used with 61885, 61886, and 61888.

You code 95974 (Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour) if the surgeon does programming or testing of the pulse generator. The relative value unit (RVU), the numeric reimbursement value associated with the services in 64568 is 18.89.