Jennifer Pohrte Aug 22, 2022 10:43:54 AM 7 min read

What to Know When Coding for Sacral Neuromodulation

Sacral Neuromodulation (SNM), also known as Sacral Nerve Stimulation (SNS), is a therapy designed to stimulate the sacral nerve and help control bladder function and fecal incontinence in patients who have failed behavioral and/or pharmacologic therapies. SNS involves the implantation of a permanent pulse generator device that transmits electrical impulses to the sacral nerve through an implanted wire. SNS requires first a temporary test stimulation to determine if an implantable stimulator would be effective, and then a permanent implantation in appropriate candidates.

In order to properly code for Sacral Neuromodulation, it’s important to understand the phases of the treatment, the common conditions addressed through the treatment, the full treatment descriptions appropriate for each case, and more.

 

Phases & CPT Codes

Patients undergo a trial phase of initial testing to see their potential response to the treatment. During this stage, a temporary lead wire is inserted and connected to an external stimulator and left in place for a brief period of 4 to 7 days. During that time, the patient logs their results in a voiding diary to determine the success rate.

After the trial period is a second test that is a 2-stage process. Stage 1 is when a permanent lead is placed while still using the temporary generator to see how the patient responds. This phase can last several weeks to see if the patient has improvement in their symptoms. Then, they can proceed to Stage 2 where the permanent device is implanted.

Codes:

Basic Test/Trial Phase:

  • 64561 percutaneous placements of the temporary electrodes

Advanced Trial/Stage 1:

  • 64581 open incision placements of the temporary or permanent electrodes & generator

Full System Implant/Stage 2:

  • 64581 placements of the permanent electrode
  • 64590 placement of the neurostimulator pulse generator

 

ICD-10 CM Codes Commonly Treated

  • N32.81 Overactive Bladder
  • N39.41 Urge Incontinence
  • R33.8 Other Retention of Urine
  • R33.9 Retention of Urine, Unspecified
  • R35.0 Frequency of Micturition
  • R29.14 Feeling of Incomplete Bladder Emptying
  • R15.9 Full incontinence of feces

 

CPT Codes Full Descriptions

  • 64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including imaging guidance, if performed
  • 64581 Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)
  • 64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling
  • 64585 Revision or removal of peripheral neurostimulator electrode array
  • 64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver
  • 76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time
  • 95970 Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming
  • 95971 Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with simple spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional
  • 95972 Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional

 

Additional Coding Information

  • 64561 can be billed bilateral with Modifier 50 (if done on both sides)
  • Can report 76000 with 64581 (not included), but do not report 76000 with 64561 (included)
  • Do not report removal of an existing lead when a new lead is replaced
  • Do not report 64590 in conjunction with 64595
  • Simple programming includes adjustment of one to three parameter(s)
  • Complex programming includes adjustment of more than three parameters

 

Global Days

  • 10-day period: 64561, 64585, 64590 (may need Modifier 58), and 64595
  • 90-day period: 64581

 

Medical Necessity Requirements

Be aware of the following medical necessity requirements:

  • The patient must be diagnosed with one of the conditions listed above and the procedure must be linked to that ICD10 Code
  • The chart record must include documentation of the failure in conventional conservative therapies such as behavioral training and pharmacologic treatments
  • The patient’s incontinence cannot be related to a spinal cord injury or a progressive, systemic neurologic condition, such as MS or diabetic neuropathy

 

Still have questions about billing for SNS? MMG is here to help. Reach out to start the conversation today.