Friday, March 17, 2017

CPT 64566 - PTNS for uninary control

CPT/HCPCS Codes

Group 1 Codes:

64566 Neuroeltrd stim post tibial

Coverage Indications, Limitations, and/or Medical Necessity

Background

Posterior Tibial Nerve Stimulation (PTNS), a minimally invasive procedure, consists of insertion of an acupuncture needle above the medial malleolus into a superficial branch of the posterior tibial nerve. An adjustable low voltage electrical impulse (10mA, 1-10 Hz frequency) travels via the posterior tibial nerve to the sacral nerve plexus to alter pelvic floor function by neuromodulation.

Indications

Studies demonstrate that PTNS is safe with statistically significant improvements in the clinical assessment of overactive bladder (OAB) (urge incontinence) and may be considered a clinically significant alternative to failed pharmacotherapy. Treatment regimens consist of 30-minute weekly sessions for 12 weeks.

Limitations

Patients must report an improvement in urge incontinence within 6 weeks (i.e., 6 sessions) of initiation of PTNS for continued coverage.

Treatment beyond the initial 12 sessions will be allowed at a frequency of 1 every 1 to 2 months for the remainder of one year. Subsequent treatment will not be covered.

Stress and neurogenic incontinence would not be expected to improve with PTNS.

There is currently no data that shows sustained improved urge incontinence after one year.


Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

999x Not Applicable

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable


ICD-10 Codes that Support Medical Necessity

ICD-10 CODE DESCRIPTION

N39.41 Urge incontinence
N39.46 Mixed incontinence
R32 Unspecified urinary incontinence


CODES NUMBER DESCRIPTION

CPT codes for percutaneous implantation of neurostimulator electrodes (i.e., 64553, 64555,

64561, 64565, 64590) are not appropriate since PTNS uses percutaneously temporarily inserted needles and wires rather than percutaneously implanted electrodes that are left in place.

CPT 64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming

64999 Unlisted procedure, nervous system HCPCS L8679 Implantable neurostimulator, pulse generator, any type L8680 Implantable neurostimulator electrode, each

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