Wiki InterStim Therapy-My doctors are

[micalbee65]

My doctors are considering a new procedure InterStim Therapy. We will be billing out 64561 along with the Supply codes.
Is anyone performing these procedures and if so how is your reimbursement for the supplies?
Thanks
Bonnie

 

[sopbs]

Stage 1 we do in office and bill 64581; Stage 2 done in hospital and bill 64590-58 and 95972. If all done in one day 64581, 64590 and 95972 cpt code 76000 or 77002 may be used for flouroscopy. Covered diagnosis codes are 788.21, 788.41, 788.31 or 788.20. Keep in mind there are certain policy requirements for each insurance example medicare requires pt have symptoms for at least one year and presents limitation in patient's activities, conservative methods have failed, tried at least 2 drugs and have failied for retention patients catherterization is not tolerated or has failed and for all patients a test must be performed with at least 50% improvement in symptoms to have the stage 2. Very important to know what each insurance company requires.

 

[sopbs]

Sorry I failed to mention on stage one you bill it 64581LT and 64581RT!

 

[lisashernandez]

Here is a billing worksheet that I've used for the InterStim that might be helpful.

http://www.tamethepain.com/wcm/groups/mdtcom_sg/@mdt/@neuro/documents/documents/wcm_prod061860.pdf

Lisa

 

[gabrielmartinez]

INTERSTIM STAGE 1 Vs 2

for interstim Stage 1 we bill 64561-LT, 64561-RT-59 and 95972 for Stage 2 we bill 64581 64590 and 95972 ? this comes from Our Medtronic Rep ???

 

[kenkie79]

Our system won't let us bill 95972 for 788.31 because it claims that it doesn't justify 95972 which is crazy to me. The patient has Medicare though so this is likely the problem. I don't see why it wouldn't be justified.

 

[Kelly_Mayumi]

Is there an LCD or NCD that supports the use of the dx code w/that cpt?

 

[KMCFADYEN]

I show no states have an LCD on this code. However, there are specific diagnoses that cross reference with 95972:

Cross ReferencesCPT? → ICD-9-CM
332.0 Paralysis agitans333.1 Essential and other specified forms of tremor
345.41 Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy
345.51 Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy
625.6 Stress incontinence female
788.32 Stress incontinence male
996.2 Mechanical complication of nervous system device implant and graft
V53.02 Fitting and adjustment of neuropacemaker (brain) (peripheral nerve) (spinal cord)