Urology Coding Alert

Differentiate infection and hardware failure with specific diagnostic codes.

In the Urology Coding Alert Vol. 5, No. 7 article "4 Tips Help Stimulate Your SNS Reimbursement Success" you learned how to code when your urologist performs sacral nerve stimulation (SNS) placement procedures. But how do you code when the patient has problems with the leads or the generator, and your urologist must remove and/or replace the devices?

Occasionally, problems arise with the lead and/or the generator after they have been implanted for SNS therapy. For example, a patient presents with non-obstructive urinary retention, and the urologist evaluates the patient and determines that she is a prime candidate for SNS. However, soon after the lead and generator have been implanted, one of the two components malfunctions.

As in this example, not all SNS placements are successful, and patients may need their leads or generator removed or replaced for a variety of reasons. Don’t worry, however; the coding for these procedures is less complicated than coding for the original placement procedures. Read on to learn how you should report your urologist’s work in these clinical scenarios.

Choose Between 64585, 64595 for Removal

To code the removal of the permanent lead, you should report 64585 (Revision or removal of peripheral neurostimulator electrode array) and for the removal of the generator, you’d use 64595 (Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver), says Nina Mutone, MD, MPH, urogynecologist with Urology of Indiana in Indianapolis.

Tip: You will use these two codes if your urologist removes, but does not replace, the lead or generator, says Becky Boone, CPC, CUC, urology surgery coder for The Coding Network and cardiology coder for the University of Missouri Internal Medicine Department in Columbia.

Alter Your Coding for Replacement

If your urologist replaces the patient’s generator, you should report 64590 (Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling). Code 64590 includes the removal of the prior placed generator and you should not also report 64595. The CPT® manual reinforces this with a note following 64590 that states: "Do not report 64590 in conjunction with 64595."

For replacement of the electrode, you’ll just report 64585 as noted above. This coding includes the incisional placement of a new electrode.

Pinpoint the Removal Reason

There are a variety of reasons a patient may need their device removed or replaced. "The two main problems are malfunction or infection," says Boone. "I’ve seen them malfunction more; patients tend to fall on them or have battery problems."

Additionally: You might see some other reasons for removal or reimplantation of the leads or generator, Mutone says. Some include "for pain at the site, failure of patient to respond to treatment and desire to have it removed, or need to have an imaging study which is contraindicated in the presence of the device (e.g., any MRI other than head MRI, which was recently approved by FDA as okay to do in patients with implanted sacral nerve stimulator)," she adds.

Depending on the problem the patient has, you might use one of the following diagnosis codes, for example:

• 996.2 — Mechanical complication of nervous system device implant and graft
• 996.63 — Infection and inflammatory reaction due to nervous system device implant and graft
• 996.75 — Other complications due to nervous system device implant and graft.

Example: A patient presents with urge incontinence and proves to be a candidate for SNS. Two months after the implantation of the generator, the patient presents with severe infection from one of the implanted permanent devices. You should use 64585 for the removal of the permanent lead and 64595 for the removal of the permanent generator. The applicable ICD-9 code for the infection in this case is 996.63. Note that when an infection is the primary source of the complication, you may also need to report a code for debridement of the infected skin, such as 11042 (Debridement; skin, and subcutaneous tissue).