How To Use CPT Code 64561

CPT 64561 involves the percutaneous implantation of a neurostimulator electrode array in the sacral nerve region, including image guidance if performed. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64561 procedures.

1. What is CPT 64561?

CPT 64561 is a medical procedure code used to describe the percutaneous implantation of a neurostimulator electrode array in the sacral nerve region. This procedure is performed to reduce pain along the path of the nerve by stimulating the motor nerves. Image guidance may be used during the procedure to accurately locate the sacral nerves and place the electrodes transforaminally.

2. 64561 CPT code description

The official description of CPT code 64561 is: “Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed.”

3. Procedure

The 64561 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider fixes electrodes around the sacral nerves.
3. Neurostimulator electrodes are implanted near the sacral nerves, not penetrating the skin more than one-half inch.
4. Using imaging guidance, the provider locates the sacral nerves and places the electrodes transforaminally, or into the opening on the side of the spine, called the foramen, where the nerve root exits.
5. The motor nerves are stimulated to reduce pain sensation along the course of the nerve.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 64561 services are those experiencing chronic pain in the sacral region that has not responded to conservative treatments such as medication, physical therapy, or other non-invasive interventions. The procedure may also be considered for patients with nerve-related pain conditions such as interstitial cystitis, pelvic pain, or urinary incontinence.

5. When to use CPT code 64561

It is appropriate to bill the 64561 CPT code when the provider performs a percutaneous implantation of a neurostimulator electrode array in the sacral nerve region, including image guidance if performed, for the purpose of reducing pain along the path of the nerve. This code should be used only when the procedure is performed in the sacral region and not in other areas such as the cervical region.

6. Documentation requirements

To support a claim for CPT 64561, the following information should be documented:

• Patient’s medical history and relevant diagnostic tests
• Indication for the procedure, including the patient’s chronic pain condition and failure of conservative treatments
• Details of the procedure, including the use of imaging guidance, electrode placement, and nerve stimulation
• Post-procedure care and follow-up instructions
• Outcome of the procedure, including any complications or adverse events

7. Billing guidelines

When billing for CPT code 64561, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 64561 include:

• Ensure that the procedure is medically necessary and supported by the patient’s medical history and diagnostic tests.
• Document the procedure thoroughly, including the use of imaging guidance, electrode placement, and nerve stimulation.
• Use the appropriate modifiers if necessary, such as -26 for the professional component of the imaging guidance.
• Be aware of any payer-specific guidelines or requirements for billing CPT code 64561.

8. Historical information

CPT 64561 was added to the Current Procedural Terminology system on January 1, 2002. There have been updates to the code since its addition:

• Code Changed on 01-01-2012: Percutaneous implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)
• Code Changed on 01-01-2013: Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

9. Similar codes to CPT 64561

Five similar codes to CPT 64561 and how they differentiate from CPT 64561 are:

1. CPT 61885 and 61886 involve the implantation of neurostimulator electrodes in the cervical region, rather than the sacral region.
2. CPT 64585 is used for the repair or removal of a peripheral neurostimulator, not the implantation.
3. CPT 64999 is used for percutaneous electrical neuromuscular stimulation or neuromodulation using needles or needle electrodes, not the implantation of a neurostimulator electrode array.
4. CPT 64590 involves the insertion or replacement of a pulse generator for a sacral nerve neurostimulator, not the implantation of the electrode array.

10. Examples

Here are 10 detailed examples of CPT code 64561 procedures:

1. A patient with chronic pelvic pain undergoes percutaneous implantation of a neurostimulator electrode array in the sacral nerve region, with image guidance used to accurately place the electrodes.
2. A patient with interstitial cystitis receives a sacral nerve neurostimulator electrode array implantation to help manage their pain and urinary symptoms.
3. A patient with chronic low back pain undergoes a CPT 64561 procedure after conservative treatments have failed to provide relief.
4. A patient with urinary incontinence receives a sacral nerve neurostimulator electrode array implantation to help control their symptoms.
5. A patient with chronic sacral nerve pain undergoes a CPT 64561 procedure, with image guidance used to ensure accurate electrode placement.
6. A patient with a history of failed back surgery syndrome undergoes a sacral nerve neurostimulator electrode array implantation to help manage their residual pain.
7. A patient with pudendal neuralgia receives a CPT 64561 procedure to help alleviate their chronic pain.
8. A patient with coccydynia undergoes a sacral nerve neurostimulator electrode array implantation after conservative treatments have been unsuccessful.
9. A patient with chronic prostatitis receives a CPT 64561 procedure to help manage their pain and urinary symptoms.
10. A patient with sacroiliac joint dysfunction undergoes a sacral nerve neurostimulator electrode array implantation to help alleviate their chronic pain.