ABBOTT CODING GUIDE DEEP BRAIN STIMULATION (DBS) Effective January 1, 2018 - INTRO - St. Jude Medical
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
INTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
ABBOTT CODING GUIDE
DEEP BRAIN STIMULATION (DBS)
Effective January 1, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
DEEP BRAIN STIMULATION
Effective January 1, 2018
Introduction Disclaimer
The Deep Brain Stimulation Coding Guide is intended to provide This document and the information contained herein is for general
general reference information for reimbursement when used information purposes only and is not intended and does not constitute
consistently with the product’s labeling. This guide includes legal, reimbursement, coding, business or other advice. Furthermore,
information regarding coverage, coding and reimbursement. it is not intended to increase or maximize payment by any payer.
Nothing in this document should be construed as a guarantee by
Abbott regarding levels of reimbursement, payment or charge, or that
reimbursement or other payment will be received. Similarly, nothing
in this document should be viewed as instructions for selecting any
Reimbursement Hotline particular code. The ultimate responsibility for coding and obtaining
Abbott offers a reimbursement hotline, which provides live coding payment/reimbursement remains with the customer. This includes
and reimbursement information from dedicated reimbursement the responsibility for accuracy and veracity of all coding and claims
specialists. Coding and reimbursement support is available from submitted to third-party payers. Also note that the information
8 a.m. to 5 p.m. Central Time, Monday through Friday at (855) presented herein represents only one of many potential scenarios,
569-6430. This guide and all supporting documents are available based on the assumptions, variables and data presented. In addition,
at https://www.sjm.com/en/professionals/resources-and- the customer should note that laws, regulations, coverage and
reimbursement. Coding and reimbursement assistance is provided coding policies are complex and updated frequently. Therefore, the
subject to the disclaimers set forth in this guide. customer should check with their local carriers or intermediaries
often and should consult with legal counsel or a financial, coding or
reimbursement specialist for any coding, reimbursement or billing
questions or related issues. This information is for reference purposes
only. It is not provided or authorized for marketing use.
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Physician 1
CPT™ DESCRIPTION WORK NATIONAL MEDICARE RATE
CODE2 RVU
FACILITY NON FACILITY
DIAGNOSTIC SERVICES
Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without
70551-26 1.48 $76 $76
contrast material
3-D rendering with interpretation and reporting of computed tomography,
magnetic resonance imaging, ultrasound or other tomographic modality with
76376-26 0.20 $10 $10
image post processing under concurrent supervision; not requiring image post
processing on an independent workstation
3-D rendering with interpretation and reporting of computed tomography,
magnetic resonance imaging, ultrasound or other tomographic modality with
76377-26 0.79 $41 $41
image post processing under concurrent supervision; requiring image post
processing on an independent workstation
LEAD PROCEDURES
Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation
of neurostimulator electrode array in subcortical site (e.g., thalamus, globus
61863 20.71 $1,580 NA
pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use
of intraoperative microelectrode recording; first array
It is incumbent upon the physician to determine which, if any modifiers should be used first. A list of CPT™ code modifiers can be found at http://professional.sjm.com/resources Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Physician1
CPT™ DESCRIPTION WORK NATIONAL MEDICARE RATE
CODE2 RVU
FACILITY NON FACILITY
LEAD PROCEDURES (CONTINUED)
Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation
of neurostimulator electrode array in subcortical site (e.g., thalamus globus
61864 pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of 4.49 $301 NA
intraoperative microelectrode recording; each additional array (List separately in
addition to primary procedure)
Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation
of neurostimulator electrode array in subcortical site (e.g., thalamus globus
61867 33.03 $2,400 NA
pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of
intraoperative microelectrode recording; first array
Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation
of neurostimulator electrode array in subcortical site (e.g., thalamus globus
61868 pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of 7.91 $530 NA
intraoperative microelectrode recording; each additional array (List separately in
addition to primary procedure)
61880 Revision or removal of intracranial neurostimulator electrodes 6.95 $596 NA
INTRAOPERATIVE STIMULATION WITH MICROELECTRODE RECORDING
Functional cortical and subcortical mapping by stimulation and/or recording of
electrodes on brain surface, or of depth electrodes, to provoke seizures or identify
95961-26 2.97 $166 $166
vital brain structures; initial hour of attendance by a physician or other qualified
health care professional
It is incumbent upon the physician to determine which, if any modifiers should be used first. A list of CPT™ code modifiers can be found at http://professional.sjm.com/resources Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Physician 1
CPT™ DESCRIPTION WORK NATIONAL MEDICARE RATE
CODE2 RVU
FACILITY NON FACILITY
INTRAOPERATIVE STIMULATION WITH MICROELECTRODE RECORDING (CONTINUED)
Functional cortical and subcortical mapping by stimulation and/or recording of
electrodes on brain surface, or of depth electrodes, to provoke seizures or identify
95962-26 vital brain structures; each additional hour of attendance by a physician or other 3.21 $178 $178
qualified health care professional (List separately in addition to code for primary
procedure)
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES
Insertion or replacement of cranial neurostimulator pulse generator or receiver,
61885 6.05 $538 NA
direct or inductive coupling; with connection to a single electrode array
Insertion or replacement of cranial neurostimulator pulse generator or receiver,
61886 9.93 $885 NA
direct or inductive coupling; with connection to two or more electrode arrays
61888 Revision or removal of cranial neurostimulator pulse generator or receiver 5.23 $417 NA
IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING*
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude, pulse duration, configuration of wave form, battery status,
electrode selectability, output modulation, cycling, impedance and patient
95970* 0.45 $25 $71
compliance measurements); simple or complex brain, spinal cord, or peripheral
(i.e., cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator
pulse generator/transmitter, without reprogramming
* A physician or an auxiliary person employed by and under the direct supervision of that physician may provide, with or without the support of the manufacturer's representative, analysis and programming of a patient's
medical product or device "incident to" the physician's other services performed in the office setting. A patient or his payer should not be billed for analysis or programming service performed at the direction of the physi-
cian by a manufacturer's representative. Contact your MAC or other payer for any questions regarding coverage, coding and payment.
It is incumbent upon the physician to determine which, if any modifiers should be used first. A list of CPT™ code modifiers can be found at http://professional.sjm.com/resources Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Physician 1
CPT™ DESCRIPTION WORK NATIONAL MEDICARE RATE
CODE2 RVU
FACILITY NON FACILITY
IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING* (CONTINUED)
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude, pulse duration, configuration of wave form, battery status,
electrode selectability, output modulation, cycling, impedance and patient
95971* 0.78 $42 $52
compliance measurements); simple spinal cord, or peripheral (i.e., peripheral nerve,
sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, with
intraoperative or subsequent programming; three or fewer parameters
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude, and duration, battery status, electrode selectability and
95978* polarity, impedance and patient compliance measurements), complex deep 3.50 $198 $258
brain neurostimulator pulse generator/transmitter, with initial or subsequent
programming; first hour; with four or more parameters
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude, and duration, battery status, electrode selectability and
polarity, impedance and patient compliance measurements), complex deep
95979* 1.64 $92 $111
brain neurostimulator pulse generator/transmitter, with initial or subsequent
programming; each additional 30 minutes after first hour (List in addition to code
for primary procedure)
* A physician or an auxiliary person employed by and under the direct supervision of that physician may provide, with or without the support of the manufacturer's representative, analysis and programming of a patient's
medical product or device "incident to" the physician's other services performed in the office setting. A patient or his payer should not be billed for analysis or programming service performed at the direction of the physi-
cian by a manufacturer's representative. Contact your MAC or other payer for any questions regarding coverage, coding and payment.
It is incumbent upon the physician to determine which, if any modifiers should be used first. A list of CPT™ code modifiers can be found at http://professional.sjm.com/resources Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Outpatient 3
CPT™ STATUS NATIONAL
DESCRIPTION APC
CODE2 INDICATOR MEDICARE RATE
DIAGNOSTIC SERVICES
70450 Computed tomography, head or brain; without contrast material Q3 5522 $119
Magnetic resonance (e.g., proton) imaging, brain (including brain stem);
70551 Q3 5523 $245
without contrast material
3-D rendering with interpretation and reporting of computed tomography,
magnetic resonance imaging, ultrasound, or other tomographic modality with
76376 N NA Packaged
image post processing under concurrent supervision; not requiring image
post processing on an independent workstation
3-D rendering with interpretation and reporting of computed tomography,
magnetic resonance imaging, ultrasound, or other tomographic modality with
76377 N NA Packaged
image post processing under concurrent supervision; requiring image post
processing on an independent workstation
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES, REVISION OR REPLACEMENT
Insertion or replacement of cranial neurostimulator pulse generator or
61885 receiver, direct or inductive coupling; with connection to a single electrode J1 5463 $18,368
array
Insertion or replacement of cranial neurostimulator pulse generator or
61886 receiver, direct or inductive coupling; with connection to two or more J1 5464 $27,890
electrode arrays
61888 Revision or removal of cranial neurostimulator pulse generator or receiver J1 5462 $6,055
J1 = Hospital Part B services paid through a comprehensive APC
N = Items and services packaged into APC rates
Q3 = Codes subject to payment as part of a composite
Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Outpatient 3
CPT™ STATUS NATIONAL
DESCRIPTION APC
CODE2 INDICATOR MEDICARE RATE
LEAD REVISION OR REMOVAL
61880 Revision or removal of intracranial neurostimulator electrode Q2 5461 $2,879
IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude, pulse duration, configuration of wave form, battery
status, electrode selectability, output modulation, cycling, impedance and
95970* Q1 5734 $105
patient compliance measurements); simple or complex brain, spinal cord, or
peripheral (i.e., cranial nerve, peripheral nerve, sacral nerve, neuromuscular)
neurostimulator pulse generator/transmitter, without reprogrammingb
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude, pulse duration, configuration of wave form, battery status,
electrode selectability, output modulation, cycling, impedance and patient
95971* compliance measurements); simple spinal cord, or peripheral (i.e., peripheral S 5742 $115
nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/
transmitter, with intraoperative or subsequent programmingb; three or fewer
parameters
Q1 = Separately payable unless performed on the same date as a HCPCS codes with a status indicator of "S", "T", or another Q1
Q2 = T-packaged codes
S = Procedures or service, not discounted when multiple
* A physician or an auxiliary person employed by and under the direct supervision of that physician may provide, with or without the support of the manufacturer's representative, analysis and programming of a patient's
medical product or device "incident to" the physician's other services performed in the office setting. A patient or his payer should not be billed for analysis or programming service performed at the direction of the physi-
cian by a manufacturer's representative. Contact your MAC or other payer for any questions regarding coverage, coding and payment.
b
Parameters include: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alter-
nating electrode polarities, dose time (stimulation parameters changing in time periods of minutes including dose lockout times), more than on clinical feature (e.g., rigidity, dyskinesia, tremor).
Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Outpatient 3
CPT™ STATUS NATIONAL
DESCRIPTION APC
CODE2 INDICATOR MEDICARE RATE
IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING (CONTINUED)
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude and duration, battery status, electrode selectability and
95978* polarity, inpedance and patient compliance measurements), complex deep S 5742 $115
brain neurostimulator pulse generator/transmitter, with initial or subsequent
programming; first hourb; four or more parameters
Electronic analysis of implanted neurostimulator pulse generator system (e.g.,
rate, pulse amplitude and duration, battery status, electrode selectability and
polarity, inpedance and patient compliance measurements), complex deep
95979* N NA Packaged
brain neurostimulator pulse generator/transmitter, with initial or subsequent
programming; each additional 30 minutes after first hour (List separately in
addition to code for primary procedure)b
N = Items and services packaged into APC rates
S = Procedures or service, not discounted when multiple
* A physician or an auxiliary person employed by and under the direct supervision of that physician may provide, with or without the support of the manufacturer's representative, analysis and programming of a patient's
medical product or device "incident to" the physician's other services performed in the office setting. A patient or his payer should not be billed for analysis or programming service performed at the direction of the physi-
cian by a manufacturer's representative. Contact your MAC or other payer for any questions regarding coverage, coding and payment.
b
Parameters include: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alter-
nating electrode polarities, dose time (stimulation parameters changing in time periods of minutes including dose lockout times), more than on clinical feature (e.g., rigidity, dyskinesia, tremor).
Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Ambulatory Surgery Center (ASC) 4
CPT™ PAYMENT MULTI-PROCEDURE NATIONAL
DESCRIPTION
CODE2 INDICATOR DISCOUNT MEDICARE RATE
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES
Insertion or replacement of cranial neurostimulator pulse
61885 generator or receiver, direct or inductive coupling; with J8 N $16,419
connection to a single electrode array
Insertion or replacement of cranial neurostimulator pulse
61886 generator or receiver, direct or inductive coupling; with J8 N $23,105
connection to two or more electrode arrays
Revision or removal of cranial neurostimulator pulse generator or
61888 G2 N $3,101
receiver
LEAD REVISION OR REMOVAL
61880 Revision or removal of intracranial neurostimulator electrodes G2 N $1,500
J8 = Device intensive procedure; paid at adjusted rate
G2 = Non-office-based surgical procedure added in CY2008 or later; payment based on OPPS relative payment weight
Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4 PAGE 5
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Inpatient 5
ICD-10 TYPICAL MS-DRG NATIONAL
DESCRIPTION
PCS CODE ASSIGNMENT MEDICARE RATE
IMPLANTATION OF LEAD(S) ONLY
025 $25,959
with MCC
00H00MZ Insertion of neurostimulator lead into brain, open approach 026 $18,079
with CC
00H03MZ Insertion of neurostimulator lead into brain, percutaneous approach
027 $14,253
without CC/MCC
IMPLANTATION OF IMPLANTABLE PULSE GENERATORS (IPG) ONLY
Insertion of single array stimulator generator into chest subcutaneous tissue
0JH60BZ 040 $22,960
and fascia, open approach with MCC
Insertion of multiple array stimulator generator into chest subcutaneous tissue
0JH60DZ
and fascia, open approach 041 $14,051
with CC
Insertion of stimulator generator into abdomen subcutaneous tissue and fascia,
0JH80MZ
open approach 042 $11,511
without CC/MCC
Insertion of stimulator generator into abdomen subcutaneous tissue and fascia,
0JH83MZ
percutaneous approach
Effective Dates: October 1, 2017 - September 30, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4 PAGE 5
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Inpatient 5
ICD-10 TYPICAL MS-DRG NATIONAL
DESCRIPTION
PCS CODE ASSIGNMENT MEDICARE RATE
IMPLANTATION OF LEAD(S) AND IMPLANTABLE PULSE GENERATOR (IPG) SINGLE ARRAY GENERATOR PLUS LEAD(S)
CHOOSE ONE OF THE FOLLOWING 025 $25,959
with MCC
026 $18,097
with CC
00H00MZ Insertion of neurostimulator lead into brain, open approach
027 $14,253
00H03MZ Insertion of neurostimulator lead into brain, percutaneous approach without CC/MCC
OR
PLUS ONE OF THE FOLLOWING MULTIPLE ARRAY GENERATOR PLUS LEAD(S)
Insertion of single array stimulator generator into chest subcutaneous tissue
0JH60BZ 023
and fascia, open approach
with MCC $33,142
Insertion of multiple array stimulator generator into chest subcutaneous or chemo implant
0JH60DZ
tissue and fascia, open approach
0JH80MZ
Insertion of stimulator generator into abdomen subcutaneous tissue and 024
fascia, open approach with CC $23,097
Insertion of stimulator generator into chest subcutaneous tissue and fascia,
0JH83MZ
percutaneous approach
Effective Dates: October 1, 2017 - September 30, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4 PAGE 5
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Inpatient 5
ICD-10 TYPICAL MS-DRG NATIONAL
DESCRIPTION
PCS CODE ASSIGNMENT MEDICARE RATE
REPLACEMENT OF LEAD(S) ONLY
CHOOSE ONE OF THE FOLLOWING
025 $25,959
00P00MZ Removal of neurostimulator lead from brain, open approach with MCC
00P03MZ Removal of neurostimulator lead from brain, percutaneous approach
026 $18,079
PLUS ONE OF THE FOLLOWING with CC
00H00MZ Insertion of neurostimulator lead into brain, open approach 027 $14,253
without CC/MCC
00H03MZ Insertion of neurostimulator lead into brain, percutaneous approach
Effective Dates: October 1, 2017 - September 30, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4 PAGE 5
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Inpatient 5
ICD-10 TYPICAL MS-DRG NATIONAL
DESCRIPTION
PCS CODE ASSIGNMENT MEDICARE RATE
REPLACEMENT OF IMPLANTABLE PULSE GENERATOR (IPG) ONLY
CHOOSE ONE OF THE FOLLOWING
Removal of stimulator generator from trunk subcutaneous tissue and fascia, open
0JPT0MZ
approach
040
Removal of stimulator generator from trunk subcutaneous tissue and fascia, with MCC $22,960
0JPT3MZ
percutaneous approach
PLUS ONE OF THE FOLLOWING
041
Insertion of single array stimulator generator into chest subcutaneous tissue and with CC $14,051
0JH60BZ
fascia, open approach
Insertion of multiple array stimulator generator into chest subcutaneous tissue
0JH60DZ
and fascia, open approach 042
without CC/MCC $11,511
Insertion of stimulator generator into abdomen subcutaneous tissue and fascia,
0JH80MZ
open approach
Insertion of stimulator generator into abdomen subcutaneous tissue and fascia,
0JH83MZ
percutaneous approach
REMOVAL OF LEAD(S) ONLY
025 $25,959
00P00MZ Removal of neurostimulator lead from brain, open approach with MCC
026 $18,079
with CC
00P03MZ Removal of neurostimulator lead from brain, percutaneous approach 027
without CC/MCC $14,253
Effective Dates: October 1, 2017 - September 30, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
PAGE 1 PAGE 2 PAGE 3 PAGE 4 PAGE 5
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
Hospital Inpatient 5
ICD-10 TYPICAL MS-DRG NATIONAL
DESCRIPTION
PCS CODE ASSIGNMENT MEDICARE RATE
REMOVAL OF IMPLANTABLE PULSE GENERATOR (IPG) AND LEAD(S) WITHOUT REPLACEMENT
CHOOSE ONE OF THE FOLLOWING
Removal of stimulator generator from trunk subcutaneous tissue and fascia, open
025 $25,959
0JPT0MZ with MCC
approach
Removal of stimulator generator from trunk subcutaneous tissue and fascia,
0JPT3MZ
percutaneous approach 026 $18,079
with CC
PLUS ONE OF THE FOLLOWING
00P00MZ Removal of neurostimulator lead from brain, open approach 027 $14,253
without CC/MCC
00P03MZ Removal of neurostimulator lead from brain, percutaneous approach
LEAD REVISION ONLY
00W00MZ Revision of neurostimulator lead in brain, open approach
025 $25,959
with MCC
026 $18,079
with CC
00W03MZ Revision of neurostimulator lead in brain, percutaneous approach 027 $14,253
without CC/MCC
Effective Dates: October 1, 2017 - September 30, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
HCPCS DIAGNOSIS
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
HCPCS Device Category C-Codes 2, 6
C-CODE DESCRIPTION
MEDICARE REQUIRED C-CODES FOR OUTPATIENT DEEP BRAIN STIMULATION IMPLANTS - BILLED UNDER REVENUE CODE 0278
C1767 Generator, neurostimulator (implantable), non-rechargeable
C1778 Lead, neurostimulator (implantable)
C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable)
C1787 Patient programmer, neurostimulator
HCPCS Device Codes and Description 6
HCPCS DESCRIPTION
LEAD
L8680 Implantable neurostimulator electrode, each
IMPLANTABLE PULSE GENERATOR (IPG)
L8679 Implantable neurostimulator pulse generator, any type
L8686 Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
L8688 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
PATIENT PROGRAMMER
L8681 Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
Additional information on C-Codes can be found at: https://www.sjm.com/~/media/galaxy/hcp/resources-reimbursement/reimbursement-support/shared/hcpcs-device-category-c-codes.pdf?la=en
Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
HCPCS DIAGNOSIS
CODING AND REIMBURSEMENT FOR DEEP BRAIN STIMULATION
ICD-10CM Diagnosis Codes2, 7
Diagnosis codes are used by both hospital and physicians to document the indication for the procedure.
ICD-10CM DESCRIPTION
ICD CODES THAT MAY APPLY
G20 Parkinson's Disease
G25.0 Essential Tremor
This list is a partial list of possible diagnosis codes and it is not meant to be an exhausting list representative of all diagnosis options for the procedure. It is always the responsibility of healthcare
providers to choose the most appropriate diagnosis code(s) representative of their patients' clinical condition
Additional Notes for Inpatient Coding
MCC – major complications and comorbidities; CC – complications and comorbidities
Approach value 0-Open is defined as “cutting through the skin or mucous membrane and any other body layers necessary to expose the site of
the procedure.” Insertion of neurostimulator leads via craniotomy or craniectomy is generally considered to be using an Open approach.
Approach value 3-Percutaneous is defined as “entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane
and any other body layers necessary to reach the site of the procedure.” Insertion of a neurostimulator lead via burr hole is generally considered
to be using a percutaneous approach. See pg 1124 in 2017 ICD-10-PCS Code Tables and Index at https://www.cms.gov/Medicare/Coding/
ICD10/2017-ICD-10-PCS-and-GEMs.html
A multiple (channel) array stimulator has two or more ports where two or more leads can be connected. See pg 1186 in 2017 ICD-10-PCS Code
Tables and Index at https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-PCS-and-GEMs.html
Effective Dates: January 1, 2018 - December 31, 2018
References & Brief SummaryINTRO PHYSICIAN CODING HOSPITAL OUTPATIENT ASC HOSPITAL INPATIENT ADDITIONAL CODES
References
1. Physician Prospective Payment-Final rule with Comment Period and Final CY2018 Payment Rates. CMS-1676-F: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-
Federal-Regulation-Notices-Items/CMS-1676-F.html
2. CPT is a trademark of the American Medical Association
3. Hospital Outpatient Prospective Payment-Final Rule with Comment Period and Final CY2018 Payment Rates. CMS-1678-FC: https://www.cms.gov/Medicare/Medicare-Fee-for-
Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1678-FC.html
4. Ambulatory Surgical Center Payment-Final Rule CY2018 Payment Rates. CMS-1678-FC: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-
Notices-Items/CMS-1678-FC.html
5. Hospital Inpatient Prospective Payment-Final Rule with Comment Period and Final FY2018 Payment Rates. CMS-1677-F: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page-Items/FY2018-IPPS-Final-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending
6. CMS, 2018 Alpha-Numeric Index HCPS code set: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2018-Alpha-Numeric-HCPCS-File-.html
7. American Medical Association, 2018 ICD-10-CM: The Complete Official Codebook. Edition 1; 2018.
Abbott
One St. Jude Medical Dr., St. Paul, MN 55117, USA, Tel: 1.651.756 .2000
SJM.com
St. Jude Medical is now Abbott.
Rx Only
Brief Summary: Prior to using these devices, please review the Instructions for Use for a complete listing of indications,
contraindications, warnings, precautions, potential adverse events and directions for use.
Unless otherwise noted, all marks herein are trademarks of the Abbott group of companies.
© 2017 Abbott. All Rights Reserved.
25358-SJM-HER-0917-0103(1) | Item approved for U.S. use only.
References & Brief SummaryYou can also read
