What about coding for a temporary trial or test of sacral nerve stimulation? Most often this is performed by percutaneous implantation of a neuriostimulator lead or electrode. That has a 10 day global. And you would bill the code 64561 percutaneous implantation of the electrode. Go through this expert medical coding and billing article for more.
It's put in the sacral nerve through a transforaminal placement. Now, if you do this bilaterally, the 64561 does not take the 50 modifier. So you would have to use a left and right 64561 left, 64561 right. Or an alternative is to bill one code on one line with no modifier and the other code, some code on the second line with a modifier 59.
Now what about coding for permanent sacral nerve stimulation? Usually, this will occur to the four weeks after the testing trial. And under those cases, if the test was satisfactory, one would go for a permanent installation of the sacral nerve neurostimulator lead or the electrode. And you would use the medical coding option 64581.
Now this has a 90 day global. Usually, within a month’s time, one will insert the neurostimulator pulse generator which has a 10 day global and this code would be 64590. Being in the global of the 64581 you would need to add modifier 58 indicating that this was a staged procedure. Again, you may want to use the programming code, the 95972 and the fluoroscopic code may also be used following the medical coding guidelines.
Now what diagnoses would you use for sacral nerve stimulation? You would use the 596.55, detrusor sphincter dysenergia or the three urinary retention codes or the urgency incontinence, mixed incontinence without sensory knowledge, overflow incontinence or the codes for frequency of the urination 788.41.
There will be times where it will be necessary to remove the generator or the lead, the electrode lead. Removal of electrode would be 64585 and has a 10 day global. And removal of the generator would be64595. Removal of the generator has a 10 day global.
Now, your ICD diagnoses for the removal of the hardware would be 996.75 mechanical failure of the nervous system implant or 996.63 infection or inflammation of the nervous system implant.
Now there will be some confusion in the removal and replacement at the same encounter. When you remove a peripheral neurostimulator pulse generator, you should use codes 64590 as per the medical coding guidelines. These include the placement as well as the removal of the pulse generator.
Use codes 64585 with modifier 78 if for the removal of electrode in a global period. And this includes an incisional placement of electrode at the same time and the diagnoses for the removal would be 996.75 which would be mechanical failure.
Now, if you're placing an electrode not in the global period, use code 64581. This includes incision placement and its removal should not be billed. Just bill for the incisional placement.
Occasionally, the urologist will put a permanent and the temporary lead. In this particular case, the urologist put a less percutaneous insertion of an electrode and he did a right incisional insertion of electrode all on the fluoroscopic control.
Now, when we look at codes 64581 incisional implantation of an electrode and codes 64561 percutaneous implantation of electrode, you cannot bill both of these codes at the same time. The 64581 is bundled into the 64561.
Now, as per the Medicare guidelines, if you do this in your office, you can't bill both codes but you should bill the 64561 because in the office, this has a higher relative value unit than the incisional placement. If you do it in the hospital, then you should bill 64581 because this has a higher RVUs and paid more when it's done in the hospital than the 64561.
For non-Medicare you could bill both since you don’t know the carriers or usually don’t know the carrier’s bundling plan so you bill for both. The 64581, right, 64561 modifier 51 and left. And then you would bill for the fluoroscopy.
Now, within a month’s time, you're usually going to put in the pulse generator. So you would bill the 64590 using modifier 58 at the appropriate time remembering that the global for the code 64581 is 90 days and the global for the 64561 in ten days.
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