february 2014

Sacral Neurostimulators

So I was having a hard time coming up with a topic for this month’s newsletter and was thinking, what can I put out there that will actually help with coding and was reminded of the confusion that sometimes exists with coding Stage I and Stage II sacral neurostimulators.  As with most neurostimulator procedures the patient will first go through a trial period (which may be required by some carriers) before a permanent placement is performed to include implantation of the neurostimulator pulse generator/receiver.  There are two codes for electrode implantation the first being, 64561 – Percutaneous implantation of neurostimulator electrode array; sacral nerve including image guidance, if performed.  This is referred to as the Stage I procedure.  Once the trial has been completed the electrode is removed and what’s referred to as the Stage II implantation takes place.  64581 - Incision for implantation of neurostimulator electrode array; sacral nerve.   In this procedure an incision is made through the fascia to insert the lead and then the lead is tunneled subcutaneously to the area where a pocket has been developed for the generator.  The lead is attached to the generator which is inserted into the pocket and closed.  “NORMALLY” this how the services were meant to be performed.  However, I have seen variations in the way that these “Stages” are performed.  For example, some physicians will call the procedure Stage I but after placing the lead they will tunnel over to a pocket that has been developed for the generator (but the generator is not placed during this part of the service) – instead the lead will be attached to an extension and then tunneled back to original insertion site.  The other variation is when the procedure is called Stage II but from the documentation it is obvious that the lead was placed percutaneously rather than by incision.

Regardless of whether the procedure is called a Stage I or Stage II implantation the coder is going to have to review the operative report and assign a CPT code based on the actual procedure performed!


About Us    |    Privacy-Security Statement    |    Terms of Use
© 2009 mdStrategies