Billing for Spinal Cord Stimulation Trial or Permanent

Billing for Spinal Cord Stimulation Trial or Permanent

Spinal Cord Stimulation is indicated in patients who have chronic moderate to severe pain of the trunk or limbs who have failed more from the conservative treatment.

According to Laxmaiah Manchikanti, MD’s book, there are some specific criteria that a patient should meet including:
1. More conservative options have failed or are not acceptable to the patient
2. The patient should have a definable pathology to explain the current pain complaints
3. The patient should have no untreated drug addiction
4. The patient should have no unstable depression or anxiety disorders. The presence of these problems are not a contraindication, but, if present treatment should be initiated prior to implanting a permanent system
5. No contraindications should exist such as systematic infection, uncontrolled bleeding disorders, local infection at the implant site, or severely uncontrolled diabetes mellitus.
6. A trial of stimulation should be attempted prior to the permanent implant, and should give acceptable outcomes for pain relief (50% or more) and functional improvement.
7. The patient should understand the risk and expectations including nerve injury, epidural hematoma, epidural abscess, infection, paralysis, death, mechanical failure, failure to produce pain relief and risks of anesthesia

As of April 2014, HCPCS code L8680 became a non-payable code since it is bundled wih the Neurostimulator Device. The electrodes is now being bundled with the 63650
For neurostimulator devices, HCPCS code L8680 is no longer separately billable for Medicare because payment for electrodes has been incorporated in CPT code 63650 (Percutaneous implantation of neurostimulator electrode array, epidural). Providers should not not report electrode(s) using code L8680 in conjunction with a lead implantation procedure provided in any setting for Medicare.

CPT Procedure Code Utilized on Billing for Spinal Cord Stimulation Trial or Permanent

63650 Percutaneous implantation of neurostimulator electrode array, epidural
63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
63661 Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63662 Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63663 Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver

Device HCPCS Codes used When Billing for Spinal Stimulation Trial or Permanent

L8679 Implantable neurostimulatorpulse generator, any type
L8680 Implantable neurostimulator electrode (with any number of contact points), each
L8682 Implantable neurostimulator pulse generator, Dual array, nonrechargeable, includes extension
L8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686 Implantable neurostimulator pulse generator, single array, non-rechargeable
L8687 Implantable neurostimulator pulse generator, rechargeable
L8688 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension

Analysis/ Programming Codes When Billing for Spinal Stimulation Trial or Permanent

95970 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); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming
95971 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); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with reprogramming
95972 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude, pulse, durationn, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance, and paptient compliance measurements); complex spinal cord or peripheral (i.e., peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperave or subsequent programming, up to 1 hour

With the above codes when Billing for Spinal Stimulation Trial or Permanent, here are the highlights that we need to remember when billing for these codes:

RELATED ARTICLE POST: How to Bill Properly for CPT Code 63650 for Medicare Effective April 01, 2015

 

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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