Transcript Name of presentation

B. Todd Sitzman, MD, MPH
Hattiesburg, MS
SCS:
Indications
Contraindications
Medical Necessity
Disclosures
Cephalon
King Pharmaceuticals URL Pharma
-
Consultant
Consultant
Consultant
My relationships with the above corporate
entities should not bias the content of this
lecture handout or its presentation. All patient
care recommendations should be verified with
current scientific evidence and product labeling.
ICD-9: SCS Indications
• 722.83 = Failed back surgery syndrome (FBSS) or
Postlaminectomy pain syndrome
• 724.4 = Lumbar or thoracic radiculopathy
• 723.4 = Cervical radicular pain syndrome or radiculopathy
• 354.4 = Causalgia of upper limb
• 355.71 = Causalgia of lower limb
• 337.21 = CRPS type I of upper limb
• 337.22 = CRPS type II of lower limb
• 349.2 = Epidural fibrosis
• 322.2 = Arachnoiditis or lumbar adhesive arachnoiditis
• 354.9 = Peripheral neuropathy of upper limb
• 355.8 = Peripheral neuropathy of lower limb
ICD-9: SCS Indications
• 996.2
= Mechanical complication of nervous system
device implant or graft
• 996.63 =
Infection or inflammatory reaction due to
nervous system device implant and graft
SCS Contraindications
• Medical Coagulopathy
Sepsis / recurrent MRSA infections
• Psychiatric / Psychological Untreated, major comorbidity
Serious drug abuse/dependence
Inability to control SCS system / device
Secondary gain
• Technical Demand cardiac pacemaker (special monitoring required)
Electromagnetic interference (MRI*, diathermy, electrocautery)
Hyperbaric pressures (diving below 10m water or > 2 atm)
Common CPT “Lead” Codes
• 63650
• 63655
• 63661
• 63662
• 63663
• 63664
= Percutaneous implantation of neurostimutor
electrode array, epidural
= Laminectomy for implantation of neurostimulator
electrodes, plate/paddle, epidural
= Removal of spinal neurostimulator electrode
percutaneous array(s), including fluoroscopy
= Removal of electrode plate/paddle placed via
laminotomy or laminectomy, including fluoroscopy
= Revision, including replacement, of spinal
neurostimulator electrode percutaneous array,
including fluoroscopy
= Revision, including replacement, of spinal
neurostimulator electrode plate/paddle placed via
laminotomy or laminectomy, including fluoroscopy
Common CPT “Generator” Codes
• 63685
• 63688
• 95970
• 95972
• 95973
= Insertion or replacement of spinal neurostimulator
pulse generator or receiver
= Revision or removal or implanted spinal
neurostimulator pulse generator or receiver
= Electronic analysis of implanted neurostimulator
pulse generator system, without reprogramming
= Electronic analysis of implanted neurostimulator
pulse generator system, with intraoperative or
subsequent programming, first hour
= Electronic analysis of implanted neurostimulator
pulse generator system, with intraoperative or
subsequent programming, each additional 30
minutes after first hour
CMS - Requirements
FDA Labeling
"intractable pain of the trunk and limbs"
CMS Reimbursement:
1. Other treatment modalities have been exhausted
or judged to be unsuitable (Rx, surgical, physical,
psychological)
2. All facilities, equipment and personnel required
for the proper diagnosis, treatment, and follow-up
must be available
3. Permanent implantation must be preceded by a
temporary trial demonstrating pain relief
SCS Coverage and Authorization
Boston Scientific:
www.controlyourpain.com/professionals/reimbursement
Medtronic:
http://professional.medtronic.com/therapies/spinal-cordstimulation/coverage-and-reimbursement/index.htm
St. Jude Medical:
www.sjmneuropro.com/Practice-administration/index.htm
Letter of Medical Necessity
- See LOMN example in syllabus -
Thank You !
B. Todd Sitzman, MD, MPH
Hattiesburg, MS
[email protected]