Urology Coding Alert
CMS Requires Carriers To Cover Sacral Nerve Stimulation
Under the new national policy, sacral nerve stimulation is now covered for treating urinary urge incontinence, urgency-frequency syndrome and non-obstructive urinary retention. There are two parts to the treatment: a temporary stimulation to see if the stimulator would work and a permanent implantation for patients who tested well in the temporary stimulation. Medicare covers both the test and the permanent implant.
Limitations
Four limitations apply to all three indications (urge incontinence, urgency-frequency and retention):
1. The patient must be non-responsive to conventional therapy documented behavioral therapy, medication or surgery to treat the incontinence. The patient must also be an appropriate candidate for surgical implantation with anesthesia.
2. Any patient who has stress incontinence, urinary obstruction, or specific neurologic diseases, such as diabetes with peripheral nerve involvement, is excluded from this treatment.
3. The patient must first have a successful test stimulation. Before permanent implantation, he or she must demonstrate a 50 percent or greater improvement via the test stimulation. Document improvement by voiding diaries kept by the patient.
4. The patient must be able to record voiding diary data to support evaluation of the implant procedure.
Coinciding with the Medicare coverage decision, CPT has issued new codes to cover the two procedures: code 64561 (percutaneous implantation of neurostimulator electrodes; sacral nerve [transforaminal placement]) for the test and 64581 (incision for implantation of neurostimulator electrodes; sacral nerve [transforaminal placement]) for the incision for the permanent implantation.
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