february 2015

Neurostimulator Facts

Here are a few different scenarios regarding trial or temporary percutaneous electrode array(s):

  • When the physician places a percutaneous “trial” lead, the payment rate for this procedure includes removal of that temporary lead. Therefore, when a trial lead is removed without insertion of a permanent electrode array, it would not be appropriate to report the removal code 63661.
  • When the trial period ends and the physician inserts a pulse generator, then connects the existing trial lead to the pulse generator - only the pulse generator insertion code is reported (this code includes connecting the existing electrode array). It would not be appropriate to additionally report revision of the electrode array code 63663.
  • When the physician removes the trial lead and then inserts a permanent electrode array and a pulse generator report the insertion codes for both the electrode array (63650) and generator insertion code (63685).

With regards to Medicare claims you should consider the following scenarios:

  • Many of the LCD Policies have a “dual diagnosis” requirement meaning that you would need both a primary and secondary diagnosis. For example: A specific LCD may require a diagnosis for chronic pain as the primary diagnosis and then a secondary diagnosis code to describe the reason for the chronic pain such as intervertebral disc disorders. Both diagnosis codes must be present on the claim form in order to establish medical necessity.
  • Neurostimulator pulse generator and electrode array insertion codes are considered Device Intensive Procedures and as such Medicare packages payment for these devices (generators/electrode array(s)) into the ASC facility payment. ASC’s should only bill the appropriate insertion codes and add the device cost to the CPT code, billing out just one fee. CMS will not consider payment for generator or electrode HCPCS codes listed on the claim form.
  • Procedures that are considered Device Intensive are also considered to be Multiple Procedure Discount Exempt. CMS should not discount the additional procedures so that the ASC can take advantage of the packaged payment for the devices. For example: The ASC should receive 100% for the first procedure which would be the generator insertion and 100% reimbursement for insertion of the two electrode arrays. The second and third procedures should not be discounted as long as those CPT codes are found on the Multiple Procedure Discount Exempt list. Keep in mind that CMS has established an MUE table (Medically Unlikely Edits) and reimbursement will be limited to the number of units a certain CPT code can be billed.





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