Medical Coding Updates: Sacral Nerve Stimulation


There are few CPT and HCPCS medical coding updated codes that you would use for sacral nerve stimulation. For instance: 95970 and 95972. These are electronic analysis within/without program. The A code, the A4290 is a sacral nerve stimulation test lead. This would be what you would bill when you buy the sacral nerve stimulation electrode test lead that you're going to use. This will not be a payable service to you as you will see shortly. And this will be one of your expenses for doing this procedure in the office.

Now, in the beginning, when you think about using sacral nerve stimulation in a patient, it has been recommended by the company and by urologist, they do this for a quite number of years. That in the beginning, the patient should undergo with trial run of sacral nerve stimulation.

Medical Coding for the temporary trial of the sacral nerve stimulation

There are certain criteria that one must follow if one is to accept the fact that the temporary trial has been successful. It's at least the 50% improvement of the patient’s voiding abnormalities, most often urinary frequency.

We have the code 64561, percutaneous implantation of a neurostimulator electrode, that's the wire, that's a 10-day global. And you're going to pass that into the transforaminal placement into the sacral nerve foraminal 304.

Ensure Correct Use of Modifiers: Now, when you do that and you do it bilaterally, the code 64561 does not take modifier -50. So, if you do this bilaterally, you can bill the code 64561, left; and the second line 64561, right. Or, another way of billing it bilaterally when you can't enter or use modifier -50 is 64561 on one line and 64561 modifier -59 on the other line indicating that this was done bilaterally. You had bilateral insertions of the temporary neurostimulator wire and electrode.

You have two codes for evoked potential study and testing. Notice that these are only use for private carriers and they are both add-on codes. You also have a fluoroscopic guidance needle placement code, and that's the 77002.

If you do this in your office using a C-arm, you don't need to add modifier -26. When you do this procedure in the hospital and you're using the hospital fluoroscopic equipment, you must add modifier -26 to get paid. And this basically, the -26 modifier tells the carrier that, “I should only be paid for the interpretation of the film. I don't own the equipment. I don't pay for the technician or any contrast agents that may be used in the hospital.”

Medical Coding for the permanent sacral nerve stimulation

Once it has been assessed that the patient has had a satisfactory response to the temporary sacral nerve stimulation for the final or the permanent sacral nerve stimulation code, the incisional implantation of the sacral nerve stimulator wire or the electrode with the code 64581. Notice that this has a 90-day global.

Usually, after you implant the sacral nerve neurostimulator within the period after two or three weeks, you then will insert the neurostimulator pulse generator which has a 10-day global. But to do that, you must bill the 64590 with modifier -58 because it's in the global of the incisional implantation of the electrode wire. So you must add modifier -58 to indicate that this is a stage procedure and ensure the correct use of modifiers.

Anytime you use modifier -58, you will be paid the global or complete fee of that particular CPT code. Also, you would also use the 95972, the electronic analysis with the generator, with the intraoperative or subsequent office programming.

And again, if you do this, and this probably would be done most often in the hospital for the final or permanent placement of the devices for the sacral nerve stimulation, you would bill the 77002 with modifier -26. On the rare occasion, when this is done in the office, you would have to use modifier -26.

Diagnoses that indicate the medical necessity of the sacral nerve stimulation

 Your ICD diagnoses, you must remember, give the carrier the reason for you doing the service. And the diagnoses that have been reviewed and accepted as diagnoses indicating medical necessity are the following -- 596.55, detrusor sphincter dysenergia, you have the three codes for urinary retention; you have 788.31, urgency incontinence; 788.33, that's the mixed incontinence; 788.34, incontinence without sensory awareness; 788.38, overflowing continence; and urinary frequency, 788.41.

Now, on occasion, you may have to remove these apparatus/devices that you have inserted. If they become infective, or they are painful, or they eventually are not functioning well, do not help the patient. And you have two codes for that. You have the code 64585 for removal of an electrode wire. And you have the 64595 for the removal of a generator.

Now, the ICD-9 diagnostic codes that speak for the medical necessity for removal for using the above two medical coding options is 996.75, mechanical failure of the neurological implant or infection of the neurological implant, 996.63.

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