How To Use CPT Code 64590

CPT 64590 refers to the insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 64590?

CPT 64590 is a medical procedure code used to describe the insertion or replacement of a peripheral or gastric neurostimulator pulse generator or receiver, which is performed to treat acute or chronic pain, or chronic, intractable nausea and vomiting. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 64590 CPT code description

The official description of CPT code 64590 is: “Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling.”

3. Procedure

The 64590 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider selects a location for implantation of the device, usually in the abdomen, and makes an incision; or he incises the scar at the site of the original operation.
3. For a new insertion, the provider bluntly dissects the tissue and creates a pocket for the neurostimulator device. For a neurostimulator replacement, the provider carefully excises the existing generator from the subcutaneous pocket and replaces the unit.
4. The provider connects the generator to an electrode array placed previously via a separate incision at the peripheral nerve or gastric treatment site.
5. The unit is tested, and when tests are successful, the provider places the generator into the pocket and secures it to the fibrous tissue under the skin.
6. The incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 64590 services are those who suffer from acute or chronic pain that has not responded to conservative treatments, or those with chronic, intractable nausea and vomiting that has not been alleviated by other therapies. The provider must determine that the patient is an appropriate candidate for the procedure based on their medical history, symptoms, and previous treatments.

5. When to use CPT code 64590

It is appropriate to bill the 64590 CPT code when the provider performs the insertion or replacement of a peripheral or gastric neurostimulator pulse generator or receiver, as described in the procedure section. This code should be used only when the procedure is performed for the treatment of acute or chronic pain, or chronic, intractable nausea and vomiting.

6. Documentation requirements

To support a claim for CPT 64590, the following information should be documented:

• Patient’s medical history, including previous treatments and their outcomes.
• Physical examination findings and any diagnostic tests performed to determine the need for the procedure.
• Provider’s assessment and plan, including the rationale for selecting the neurostimulator procedure.
• Detailed description of the procedure, including the type of neurostimulator used, the location of the incision, and the steps taken during the insertion or replacement.
• Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 64590, it is important to follow the appropriate guidelines and rules. Do not report 64590 in conjunction with 64595, as code 64590 includes the insertion or replacement of a previously placed generator. Additionally, ensure that all required documentation is included in the patient’s medical record to support the claim.

8. Historical information

CPT 64590 was added to the Current Procedural Terminology system on January 1, 1990. There have been updates to the code since its addition, with the most recent change occurring on January 1, 2007, when the descriptor was updated to its current form.

9. Similar codes to CPT 64590

Five similar codes to CPT 64590 and how they differentiate are:

• CPT 64553: This code is for the percutaneous implantation of a neurostimulator electrode array, which is different from the insertion or replacement of the pulse generator or receiver in CPT 64590.
• CPT 64555: This code describes the implantation of a peripheral neurostimulator electrode array via an open approach, whereas CPT 64590 focuses on the insertion or replacement of the pulse generator or receiver.
• CPT 64575: This code is for the incision and implantation of a neurostimulator electrode array for the treatment of interstitial cystitis or urinary incontinence, which is a different indication than CPT 64590.
• CPT 64581: This code refers to the incision and implantation of a neurostimulator electrode array for the treatment of fecal incontinence, which is not the same as the indications for CPT 64590.
• CPT 64595: This code is for the revision or removal of a peripheral or gastric neurostimulator pulse generator or receiver, which is different from the insertion or replacement described in CPT 64590.

10. Examples

Here are 10 detailed examples of CPT code 64590 procedures:

1. Insertion of a peripheral neurostimulator pulse generator for the treatment of chronic lower back pain that has not responded to conservative treatments.
2. Replacement of a gastric neurostimulator pulse generator in a patient with chronic, intractable nausea and vomiting due to gastroparesis.
3. Insertion of a peripheral neurostimulator pulse generator for the treatment of complex regional pain syndrome in a patient’s upper extremity.
4. Replacement of a peripheral neurostimulator pulse generator in a patient with chronic migraine headaches that have not responded to other therapies.
5. Insertion of a gastric neurostimulator pulse generator in a patient with chronic, intractable nausea and vomiting due to a functional gastrointestinal disorder.
6. Replacement of a peripheral neurostimulator pulse generator in a patient with chronic pelvic pain that has not been alleviated by other treatments.
7. Insertion of a peripheral neurostimulator pulse generator for the treatment of postherpetic neuralgia in a patient’s thoracic region.
8. Replacement of a gastric neurostimulator pulse generator in a patient with chronic, intractable nausea and vomiting due to chemotherapy-induced gastroparesis.
9. Insertion of a peripheral neurostimulator pulse generator for the treatment of phantom limb pain in a patient who has undergone an amputation.
10. Replacement of a peripheral neurostimulator pulse generator in a patient with chronic neuropathic pain due to diabetic peripheral neuropathy.