SCS:IndicationsContraindicationsMedical Necessity

B. Todd Sitzman, MD, MPH

Hattiesburg, MS

Disclosures

Cephalon - ConsultantKing Pharmaceuticals - ConsultantURL Pharma - 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 withcurrent 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 = Percutaneous implantation of neurostimutor electrode array, epidural

• 63655 = Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

• 63661 = Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy

• 63662 = Removal of electrode plate/paddle placed via laminotomy or laminectomy, including fluoroscopy

• 63663 = Revision, including replacement, of spinal neurostimulator electrode percutaneous array, including fluoroscopy

• 63664 = Revision, including replacement, of spinal neurostimulator electrode plate/paddle placed via laminotomy or laminectomy, including fluoroscopy

Common CPT “Generator” Codes

• 63685 = Insertion or replacement of spinal neurostimulator pulse generator or receiver

• 63688 = Revision or removal or implanted spinal neurostimulator pulse generator or receiver

• 95970 = Electronic analysis of implanted neurostimulator pulse generator system, without reprogramming

• 95972 = Electronic analysis of implanted neurostimulator pulse generator system, with intraoperative or subsequent programming, first hour

• 95973 = 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-cord-stimulation/coverage-and-reimbursement/index.htm

St. Jude Medical: www.sjmneuropro.com/Practice-administration/index.htm

Letter of Medical Necessity

- See LOMN example in syllabus -

B. Todd Sitzman, MD, MPHHattiesburg, MStoddsitzman@msn.com

Thank You !