How To Use CPT Code 64555

CPT 64555 involves the percutaneous implantation of a neurostimulator electrode array in a peripheral nerve, excluding the sacral nerve. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64555.

1. What is CPT 64555?

CPT 64555 is a medical procedure code that refers to the percutaneous implantation of a neurostimulator electrode array in a peripheral nerve, excluding the sacral nerve. This procedure is used to treat various conditions by stimulating the targeted nerve tissue with electrical impulses generated by the neurostimulator. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 64555 CPT code description

The official description of CPT code 64555 is: “Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)”.

3. Procedure

  1. The patient is prepared for the procedure, which usually takes place in an operating room.
  2. Local anesthesia is administered to numb the area where the electrode array will be implanted.
  3. A small incision is made in the skin to access the targeted peripheral nerve.
  4. The neurostimulator electrode array is carefully inserted around the peripheral nerve, ensuring proper placement and positioning.
  5. The electrode array is connected to an insulated lead, which is then connected to a receiver unit implanted under the skin at a depth not greater than 1/2 inch.
  6. The incision is closed, and the external generator and antenna unit are attached to the skin surface over the receiver unit.
  7. The neurostimulator is tested to ensure proper functioning and stimulation of the targeted nerve tissue.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 64555 services are those who have been diagnosed with a condition that may benefit from peripheral nerve stimulation, such as chronic pain, nerve disorders, or certain types of headaches. The patient must have tried and failed conservative treatments, and the physician must determine that the potential benefits of the procedure outweigh the risks. Additionally, the targeted nerve must be a peripheral nerve, excluding the sacral nerve.

5. When to use CPT code 64555

It is appropriate to bill the 64555 CPT code when the physician has performed the percutaneous implantation of a neurostimulator electrode array in a peripheral nerve, excluding the sacral nerve, for the treatment of a qualifying condition. The procedure must be medically necessary, and the patient must meet the eligibility criteria outlined in the qualifying circumstances section.

6. Documentation requirements

To support a claim for CPT 64555, the following information must be documented in the patient’s medical record:

  • A detailed medical history, including the patient’s diagnosis and previous treatments tried.
  • A thorough physical examination, including an assessment of the targeted peripheral nerve.
  • A clear rationale for the use of peripheral nerve stimulation, including an explanation of why other treatments have failed or are contraindicated.
  • Documentation of the patient’s informed consent for the procedure.
  • A detailed description of the procedure, including the specific steps taken, the type of neurostimulator used, and the location of the targeted peripheral nerve.
  • Postoperative notes, including any complications or adverse events, as well as the patient’s response to the procedure.
  • Follow-up care plans, including any additional treatments or therapies recommended.

7. Billing guidelines

When billing for CPT code 64555, it is important to follow the specific guidelines and rules set forth by the payer. Some general tips for billing this code include:

  • Ensure that the patient’s medical record contains all required documentation to support the claim.
  • Verify that the procedure was performed on a peripheral nerve, excluding the sacral nerve.
  • Do not report CPT 64555 in conjunction with CPT 64566.
  • For percutaneous electrical stimulation of a peripheral nerve using needles or needle electrodes (e.g., PENS, PNT), use CPT 64999 instead.

8. Historical information

CPT 64555 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone two changes since its addition:

  • On January 1, 2002, the descriptor was changed to “Percutaneous implantation of neurostimulator electrodes; peripheral nerve”.
  • On January 1, 2012, the descriptor was updated to its current form: “Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)”.

9. Similar codes to CPT 64555

Five similar codes to CPT 64555 include:

  • CPT 64550: This code refers to the application of surface neurostimulator electrodes, which are placed on the skin rather than implanted.
  • CPT 64560: This code is used for the implantation of neurostimulator electrodes in the sacral nerve, which is excluded from CPT 64555.
  • CPT 64561: This code is for the revision or removal of implanted sacral nerve neurostimulator electrodes.
  • CPT 64565: This code is for the chemodenervation of a peripheral nerve using a neurolytic agent, rather than electrical stimulation.
  • CPT 64566: This code is for the percutaneous implantation of neurostimulator electrodes in the posterior tibial nerve, which is a specific type of peripheral nerve.

10. Examples

Here are 10 detailed examples of CPT code 64555 procedures:

  1. A patient with chronic migraines undergoes the implantation of a neurostimulator electrode array in the occipital nerve.
  2. A patient with trigeminal neuralgia has a neurostimulator electrode array implanted in the trigeminal nerve.
  3. A patient with peripheral neuropathy due to diabetes receives a neurostimulator electrode array implantation in the sural nerve.
  4. A patient with complex regional pain syndrome undergoes the implantation of a neurostimulator electrode array in the radial nerve.
  5. A patient with phantom limb pain following amputation has a neurostimulator electrode array implanted in the sciatic nerve.
  6. A patient with intractable facial pain undergoes the implantation of a neurostimulator electrode array in the infraorbital nerve.
  7. A patient with occipital neuralgia receives a neurostimulator electrode array implantation in the greater occipital nerve.
  8. A patient with intercostal neuralgia undergoes the implantation of a neurostimulator electrode array in the intercostal nerve.
  9. A patient with postherpetic neuralgia has a neurostimulator electrode array implanted in the affected cutaneous nerve.
  10. A patient with refractory pelvic pain undergoes the implantation of a neurostimulator electrode array in the pudendal nerve.

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