CPT copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
This article features a Q&A with Cristina Bentin, CCS-P, CPC-H, CMA, president of Coding Compliance Management. Learn more about Coding Compliance Management here.
Q: Our ASC has been receiving conflicting information from some vendors regarding the appropriate reporting of the PSTIM procedure. In regards to commercial carriers, should we report CPT code 64555, S8930, 64999, or a code(s) from the acupuncture series of codes?
Cristina Bentin: There has been considerable confusion regarding the reporting of the PSTIM™ procedure, an innovative procedure utilized to reduce or alleviate acute and chronic pain based on the principle of auricular nerve stimulation. Available information and recommendations regarding code selections have ranged from reporting CPT code 64555, reporting the unlisted code 64999, reporting from the 99XXX codes for acupuncture, or reporting HCPCS code S8930. It is important your ASC does its research.
While reporting opinions and recommendations are typically based on documentation and research information available at the time, procedure reporting can and will change as directives and guidelines change and/or become available. From a coding perspective, what may be an accurate code for one procedure may not apply to a similar procedure. In addition, code selections one day may not be correct code selections the next month. It is highly recommended that facilities and providers verify individual carrier reporting guidelines for the PSTIM™ procedure prior to performing these procedures. Facilities should not assume reimbursement information presented in the past is correct and/or still applicable at this time.
With regards to the PSTIM™ procedure, key verbiage within the procedural notes for the PSTIM™ has understandably misled some coders, consultants, and vendors to an incorrect code selection since similar terminology is also utilized in procedural notes traditionally and legitimately warranting CPT code selection 64555, Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve), thus the variances in past and current recommendations and/or reporting.
A facility may "lean" towards the reporting of CPT 64555 since this code "appears" to imply exactly that of the PSTIM™ procedure. As of this writing, according to the American Medical Association, CPT 64555 is not appropriate for the PSTIM™ procedure. According to an AMA inquiry, CPT code 64999, unlisted procedure nervous system should be reported. Facilities should understand that even these coding directives are subject to change. In addition, commercial carrier directives may differ from the AMA's recommendation and/or CMS directives/guidelines. CMS should be queried with specific questions regarding the PSTIM™ procedure and its reporting policies to include medical necessity and provider requirements when applicable.
The PSTIM™ procedure has been compared by some commercial carriers to acupuncture procedures with carrier directives ranging from the unlisted CPT code 64999 to the potential reporting of codes from the acupuncture code series. Still, other carriers consider the procedure investigational and recommend the reporting of unlisted code 64999.
Physicians not in agreement with the current AMA directive are encouraged to contact the AMA directly for a peer to peer review. The AMA may also be contacted to initiate support for the development of a code to accurately describe this procedure.
While it is common for vendors to provide facilities with reimbursement information to assist in their decision-making process, ultimately, it is the facility’s responsibility to verify and ensure correct reporting of its surgical procedures based on its carrier specific directives.
This article features a Q&A with Cristina Bentin, CCS-P, CPC-H, CMA, president of Coding Compliance Management. Learn more about Coding Compliance Management here.
Q: Our ASC has been receiving conflicting information from some vendors regarding the appropriate reporting of the PSTIM procedure. In regards to commercial carriers, should we report CPT code 64555, S8930, 64999, or a code(s) from the acupuncture series of codes?
Cristina Bentin: There has been considerable confusion regarding the reporting of the PSTIM™ procedure, an innovative procedure utilized to reduce or alleviate acute and chronic pain based on the principle of auricular nerve stimulation. Available information and recommendations regarding code selections have ranged from reporting CPT code 64555, reporting the unlisted code 64999, reporting from the 99XXX codes for acupuncture, or reporting HCPCS code S8930. It is important your ASC does its research.
While reporting opinions and recommendations are typically based on documentation and research information available at the time, procedure reporting can and will change as directives and guidelines change and/or become available. From a coding perspective, what may be an accurate code for one procedure may not apply to a similar procedure. In addition, code selections one day may not be correct code selections the next month. It is highly recommended that facilities and providers verify individual carrier reporting guidelines for the PSTIM™ procedure prior to performing these procedures. Facilities should not assume reimbursement information presented in the past is correct and/or still applicable at this time.
With regards to the PSTIM™ procedure, key verbiage within the procedural notes for the PSTIM™ has understandably misled some coders, consultants, and vendors to an incorrect code selection since similar terminology is also utilized in procedural notes traditionally and legitimately warranting CPT code selection 64555, Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve), thus the variances in past and current recommendations and/or reporting.
A facility may "lean" towards the reporting of CPT 64555 since this code "appears" to imply exactly that of the PSTIM™ procedure. As of this writing, according to the American Medical Association, CPT 64555 is not appropriate for the PSTIM™ procedure. According to an AMA inquiry, CPT code 64999, unlisted procedure nervous system should be reported. Facilities should understand that even these coding directives are subject to change. In addition, commercial carrier directives may differ from the AMA's recommendation and/or CMS directives/guidelines. CMS should be queried with specific questions regarding the PSTIM™ procedure and its reporting policies to include medical necessity and provider requirements when applicable.
The PSTIM™ procedure has been compared by some commercial carriers to acupuncture procedures with carrier directives ranging from the unlisted CPT code 64999 to the potential reporting of codes from the acupuncture code series. Still, other carriers consider the procedure investigational and recommend the reporting of unlisted code 64999.
Physicians not in agreement with the current AMA directive are encouraged to contact the AMA directly for a peer to peer review. The AMA may also be contacted to initiate support for the development of a code to accurately describe this procedure.
While it is common for vendors to provide facilities with reimbursement information to assist in their decision-making process, ultimately, it is the facility’s responsibility to verify and ensure correct reporting of its surgical procedures based on its carrier specific directives.
To contact Cristina Bentin ( cristina@ccmpro.com ) and learn more about Coding Compliance Management, visit www.ccmpro.com.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.