Wiki confused - The cpt code 64590 and cpt code

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Hibbs

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The cpt code 64590 and cpt code 64595-can anyone tell me what the difference is between these two codes?

64590-Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver
64595-Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver

To me they are the same?

If someone has a neurostimulator and the battery has died, and needs to be replaced witch code would be used?

I sure would like some clarification for these two codes if anyone can help.
 
64590 placement and replacement which involve a new pulse generator

64595 removal and revision do not involve a new or replacement pulse generator.
 
I currently have a client that is placing NEW battery/generators and using CPT-64595 and stating that CPT-64590 is NOT correct as there is no "creation of pocket" -- which is specifically included in the CPT-64590 language (Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver).
Anyone have any documentation that states that a pocket creation is not required when replacing the IPG and that CPT-64590 is the correct code for this replacement. I would really like to overturn this decision as the client is being underpaid for these procedures.
 
grn3728 said:
I currently have a client that is placing NEW battery/generators and using CPT-64595 and stating that CPT-64590 is NOT correct as there is no "creation of pocket" -- which is specifically included in the CPT-64590 language (Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver).
Anyone have any documentation that states that a pocket creation is not required when replacing the IPG and that CPT-64590 is the correct code for this replacement. I would really like to overturn this decision as the client is being underpaid for these procedures.
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Maybe this is just lack of clinical knowledge on my part, but I don't understand where the battery/generator is going if they are not creating a pocket for it. Is it just randomly floating in the patient's body??
 
csperoni said:
Maybe this is just lack of clinical knowledge on my part, but I don't understand where the battery/generator is going if they are not creating a pocket for it. Is it just randomly floating in the patient's body??
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No it is a battery change; meaning that the pocket was created with the initial implantation and this is just a swap for a new generator/battery with no changes/increase in the pocket at all.
 
grn3728 said:
No it is a battery change; meaning that the pocket was created with the initial implantation and this is just a swap for a new generator/battery with no changes/increase in the pocket at all.
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OOOHHH. I'm so glad I misunderstood. :unsure:
The provider is replacing the generator. In that case, I would use 64590. Here is additional information about that code, with my emphasis added for this exact scenario:
64590
The provider inserts or replaces a peripheral, sacral, or gastric neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection between the electrode array and the pulse generator or receiver.

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises the skin at the location of the peripheral, sacral, or gastric neurostimulator pulse generator or receiver implantation site. Peripheral nerves connect the brain and spinal cord to the body. The sacral nerves are spinal nerves that emerge from the sacral region of the lower spinal column. Gastric nerves are a network of nerves that control the function of the stomach. The provider creates a pocket, or, if replacing an already implanted device, dissects the old device from the pocket and disconnects the lead(s) to the electrode array. If replacing the generator or receiver, the provider attaches the separately implanted lead(s) to the new generator. For an initial implant, the provider subcutaneously passes the lead(s) from the electrode array by using a tunneling device to the implanted neurostimulator pulse generator or receiver, and connects the lead(s) to the generator or receiver. The provider may perform test stimulations to confirm the system is working. The provider secures the generator or receiver in the pocket and closes the incision.
 
csperoni said:
OOOHHH. I'm so glad I misunderstood. :unsure:
The provider is replacing the generator. In that case, I would use 64590. Here is additional information about that code, with my emphasis added for this exact scenario:
64590
The provider inserts or replaces a peripheral, sacral, or gastric neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection between the electrode array and the pulse generator or receiver.

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises the skin at the location of the peripheral, sacral, or gastric neurostimulator pulse generator or receiver implantation site. Peripheral nerves connect the brain and spinal cord to the body. The sacral nerves are spinal nerves that emerge from the sacral region of the lower spinal column. Gastric nerves are a network of nerves that control the function of the stomach. The provider creates a pocket, or, if replacing an already implanted device, dissects the old device from the pocket and disconnects the lead(s) to the electrode array. If replacing the generator or receiver, the provider attaches the separately implanted lead(s) to the new generator. For an initial implant, the provider subcutaneously passes the lead(s) from the electrode array by using a tunneling device to the implanted neurostimulator pulse generator or receiver, and connects the lead(s) to the generator or receiver. The provider may perform test stimulations to confirm the system is working. The provider secures the generator or receiver in the pocket and closes the incision.
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Thank you so much Christine; could you please tell me where I can find the Clinical Responsibility quote that you have above? I would love to name that as a resource. Thanks again for your time and expertise!
 
I pulled that from Codify. I'm sure other online coding software would have something similar.
 
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