Neuromodulation Update
OHSIPP supports many clinical approaches to pain management, including neuromodulation. Access to these effective therapies is very important to OHSIPP members. As a medical society that represents many of the physicians performing these neuromodulation procedures, OHSIPP has not only the greatest interest, but also has the greatest clinical expertise and experience to knowledgeably provide information and insight regarding these coding questions. As the opioid epidemic continues unabated, OHSIPP’s leadership on issues related to non-opioid pain treatments is critically important. The post here today is current as of 11/21/21 and updates that occur in the future may change or effect the accuracy of what is listed here. OHSIPP wants to make clear that, ultimately, billing and coding decisions are made on a case by case basis and are the sole responsibility of the physician who makes those decisions.
Following multiple inquiries from our membership, it is our understanding that there remains confusion regarding CPT codes 63685 (SCS) and 64590 (PNS) and their use with billing certain neurostimulation procedures and devices. These neurostimulation codes describe the creation of a distinct and separate pocket for a generator (implanted battery) or receiver (external battery).
OHSIPP has worked with leading members who perform these procedures, carefully reviewing the current CPT vignettes for these codes, and we confirm that the “physician work” that is involved with creating a separate pocket for an IPG or receiver, as long as it is a distinct and separate pocket and incision, is consistent with the current language contained within the CPT vignettes that describe the surgical procedure for these two codes. OHSIPP notes that there are multiple new products and associated procedures available today. This applies to systems that are currently available for SCS and PNS neurostimulation system containing a separate receiver that must be assembled with the electrode array and implanted intra-operatively. For those currently available systems, the FDA-approved Information For Use (IFU) outlines and requires two distinct procedural incisions as well as creating a pocket to permanently anchor the receiver, thus preventing device migration. Our physician experts also confirm that additional work must be completed to assemble the multiple device components intra-operatively.
Therefore, it is the position of OHSIPP that CPT codes 63685 and 64590 represent the work performed by the physician and are appropriate for the physician to bill as it relates to the physician work involved in creating a receiver or generator pocket, as long as there is a distinct and separate incision, and a pocket is created for the neurostimulator.
Note: Lead insertions within the first incision are billed separately, using CPT codes 63650 (SCS) and 64555 (PNS).
