CPT Assistant Then and Now: Coding Confusion When Reporting Code 64561 vs Code 64581

 CPT Assistant, October 2021, Volume 31, Issue 10, page 7

As medical terminology and the performance of services and procedures change, so do the associated reporting methods. In this feature, we will regularly revisit previously published articles to correct, revise, update, and/or reiterate long-standing information.

When codes 64561, Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement), including image guidance, if performed, and 64581, Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement), were originally published in the Current Procedural Terminology (CPT®) 2002 code set, test electrodes for implantation of a neurostimulator array would have been placed percutaneously; therefore, code 64561 would have been reported for the work involved in placing test leads. Typically, permanent leads were placed using an incisional procedure, which allowed suturing of the leads to the periosteum of the sacrum to avoid lead migration. Permanent leads were reported using code 64581.

This article provides updated information on the appropriate reporting for placement of sacral nerve neurostimulator electrode arrays using codes 64561 and 64581.

THEN

In a question and answer under the heading "Surgery: Nervous System," in the Bonus Feature: Special Q&As section (p 14) of the December 2012 issue of CPT® Assistant, information was provided to report codes 64561 for placement of temporary sacral nerve neurostimulator electrode arrays and implantable pulse generators (IPGs), and 64581 for permanent placement. The article stated that "code 64581, Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement), describes the insertion of the permanent electrode array for sacral nerve stimulation. Code 64561, Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement), including image guidance, if performed, would not be reported for placement of a permanent electrode lead that is tunneled to the IPG." In addition, it also stated that "[t]he incisional procedure (64581) differs in that the electrode array is sutured to the sacral periosteum at multiple points to avoid lead migration." This description corresponded with the original method of performing the procedure as noted in CPT® Changes 2002: An Insider's View and stated that "[a] midline incision is made over the sacrum, and the posterior surface of the sacrum on the side to be implanted is exposed. The lead electrode is then sutured to the sacral periosteum at multiple points to avoid lead migration" (pp 143-144). As the permanent leads were untined to avoid lead migration, placement was through an open or incisional approach; therefore, code 64581 would have been typically reported for that service.

NOW

Since codes 64561 and 64581 were originally published, tined leads have been introduced. Tined leads are different from untined leads because tined leads have prongs, while untined leads are smooth. Tined leads will not migrate due to the prong structure and do not need to be sutured to the periosteum to avoid lead migration. In 2018, it was determined that for percutaneous approaches, the work of performing percutaneous lead placement was similar whether temporary or permanent leads were placed. The article, "Coding Brief: Reporting Percutaneous Implantation of Neurostimulator Electrode Arrays Codes" in the October 2018 issue of CPT® Assistant (p 8) described this change and stated that "[f]or CPT 2019, the guidelines for neurostimulators (peripheral nerve) have been revised to clarify that codes 64553, 64555, and 64561 may be used to report either the temporary or permanent placement of percutaneous electrode arrays." Therefore, reporting codes 64561 and 64581 should be directed by the surgical approach for lead placement and not by the type of lead being placed (temporary or permanent). Code 64561 should be reported when temporary or permanent leads are placed percutaneously. Code 64581 should be reported when temporary or permanent leads are placed using an open approach. Either code 64561 or 64581 may be reported in conjunction with code 64590, Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling, when placing a pulse generator. Fluoroscopy is typically used to guide placement when leads are placed percutaneously and are an included component of code 64561.