Medicare Overpaid More than $636 Million for Neurostimulator Transplantation Surgeries

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After conducting a review of Medicare Part B claims for spinal neurostimulator implantation surgeries, which included insertion or replacement of the devices, DHHS’s Office of Inspector General found payment error rates as high as 72%! The review covered almost 60,000 beneficiaries who had at least 1 neurostimulator implantation surgery during the calendar years 2016 and 2017. Beneficiaries themselves paid $54 million in copays and deductibles.

When reading the report, I came to the realization that I knew very little about neurostimulator implantations, so I did what any HIM professional who’s been involved with coding would do: I set out to learn more.

A neurostimulator is a battery-powered device that is surgically implanted under a patient’s skin and connected to leads. The device itself could be compared to a pacemaker in that it is a generator programmed to send low levels of electricity through the leads to nerve fibers. Depending on the type of neurostimulator, it’s connected to other parts of the body, depending on the reason for the device.

There are numerous types of neurostimulators which include:

Some Types of Neurostimulators

  • Brain Stimulators
  • Deep Brain Stimulators
  • Transcranial Electrical Stimulators
  • Spinal Cord Stimulators
  • Cardiac Stimulator Devices
  • Cochlear Implants
  • Vagus Nerve Stimulators
  • Responsive Neurostimulation
  • Deep Brain Stimulation

Diagnoses Justifying Use of Neurostimulators

There is a multitude of diagnoses that can be treated by various types of neurostimulators. These include (but are not limited to):

  • Chronic pain
  • Movement disorders
  • Parkinson’s Disease
  • Essential tremor
  • Depression
  • Dystonia
  • Tourette Syndrome
  • Gastroparesis
  • OCD
  • Epilepsy

Neurostimulators for Epilepsy

  • Vagus Nerve Stimulators (VNS)
  • Responsive Neurostimulation (RNS)
  • Deep Brain Stimulation (DBS)

Coding and Billing for Neurostimulator Implantation/Removal, Etc.

Assigning ICD-10-CM/PCS and CPT codes for neurostimulator procedures can be complex and is dependent on many variables. Some neurostimulators are implanted first on a trial basis to make sure they will meet the patient’s particular needs and diagnosis.

Every surgical procedure begins with a diagnosis and appropriate documentation that justifies the need for the procedure. Once the appropriate diagnosis code has been assigned, the coder will determine if the procedure is open or closed, inpatient or outpatient, etc. The coder will also determine the type of device (VNS, Spinal Cord Stimulator, etc.) and what, exactly, is to be accomplished by the procedure. The generator and leads can each be implanted, removed, revised, or replaced. Where on the body is the procedure taking place? Abdomen, spinal canal, trunk, or elsewhere? Is the procedure open or percutaneous?

Due to the extreme number of variables, there’s no way to provide just a few specific codes that cover all possibilities. For this reason, the writer has included several links to coding reference guides that can be consulted. The links are in no way all-inclusive; other accurate guides can be found by searching the web. Coders don’t need reminding that the coding system, codes are updated annually or semi-annually; verify the accuracy of each and every code prior to assignment.

One last note: ICD-10-CM code shows the presence of a neurostimulator – Z96.82

As a reminder, the notes found in the Tabular List state that Z codes are provided for use when a circumstance or problem is present that influences the person’s health status, but is not in itself a current illness or injury.

Examples of Various Neurostimulator Devices

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Coding References

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