Nevro SCS trial billing

[paindoc007]

Have 2 patients with old stim systems from other companies that don't work anymore and who want to trial Nevro. one has old leads sitting at 9-10 interspace already, the other the old leads are too superior.

For patient one, I'm thinking of opening IPG pocket, using extensions, tunnel across and pop out externally, and plug into nevro IPG for a week. That way if they don't like it..it's all still sterile and can replug into old system.

Second I obviously have to go in and manipulate the leads to be at the right level first.

My question is billing wise, what do I bill for those two different procedures. Can I bill the standard 63685 for the second since I'm manipulating the leads? And for the first, is all I'm billing 95971?

Thanks guys!

---

Members don't see this ad.

 

[Timeoutofmind]

Have 2 patients with old stim systems from other companies that don't work anymore and who want to trial Nevro. one has old leads sitting at 9-10 interspace already, the other the old leads are too superior.

For patient one, I'm thinking of opening IPG pocket, using extensions, tunnel across and pop out externally, and plug into nevro IPG for a week. That way if they don't like it..it's all still sterile and can replug into old system.

Second I obviously have to go in and manipulate the leads to be at the right level first.

My question is billing wise, what do I bill for those two different procedures. Can I bill the standard 63685 for the second since I'm manipulating the leads? And for the first, is all I'm billing 95971?

Thanks guys!

Your idea for pt one seems reasonable to me...but would be curious what others have to say. Would have the impedances checked on the system by the rep from the original company though before proceeding.

For pt two... I think what is typically done in the circumstances is different than what you suggested. I think people simply leave the old system untouched. They turn it off. Then they place to percutaneous trial leads and just do a standard trial and take them out if it doesn't work. If it does work… During the permanent ... proceed as usual with the added step of having to take the old system out at that time. that way you have not burned your bridges if they don't like the new system that way you have not burned your bridges if they don't like the new system during the trial.

 

[BobBarker]

1. I would just swap directly to a Nevro IPG

2. Retrial

 

[paindoc007]

Your idea for pt one seems reasonable to me...but would be curious what others have to say. Would have the impedances checked on the system by the rep from the original company though before proceeding.

For pt two... I think what is typically done in the circumstances is different than what you suggested. I think people simply leave the old system untouched. They turn it off. Then they place to percutaneous trial leads and just do a standard trial and take them out if it doesn't work. If it does work… During the permanent ... proceed as usual with the added step of having to take the old system out at that time. that way you have not burned your bridges if they don't like the new system that way you have not burned your bridges if they don't like the new system during the trial.

Hmm interesting. I havent done this before. I'm curious, can 4 leads typically simultaneously sit in the epidural space comfortably? Figured it'd be hard to manipulate 2 new leads into the right spot with existing leads already there, but maybe not.

 

[Timeoutofmind]

Hmm interesting. I havent done this before. I'm curious, can 4 leads typically simultaneously sit in the epidural space comfortably? Figured it'd be hard to manipulate 2 new leads into the right spot with existing leads already there, but maybe not.

I am doing one next week.

I know this is commonly done from talking to my rep.

Remember, the contacts are going to be quite a bit below the contacts of the leads that are already in there... so I don't think the space issue will be as pronounced as trying to fit four contacts all right next to each other

 

[Tapspatellas]

If they are st Jude leads and you are going to try plugging right in, be prepared that they won't fit FYI and warn your patient that is a chance.

 

[gdub25]

My short answer opinion: perc trail them both.

I'm in practice where patients were implanted with Medtronic for many years and I'm inheriting a bunch of them. Many say their stims don't work well anymore and I have a lot of experience with changing them over. If they initially responded well to stimulation you have a very good chance of them doing well with simply swapping out IPG if leads are over T9-10. Nevro is gathering data on this now and hopefully we'll have some guidelines soon about success rates to help our decision making. I'm 6 for 6 so far with just switching out IPGs. However, this could be an expensive misstep if it doesn't work so what I've started doing is trialing every patient that I can. Between me and my partners we've done a bunch, maybe 20-30 patients, and we simply do a perc trial like normal. If the patient has two perc leads implanted we try to run one trial lead in between them. If it goes easy we might put a second but from what we're seeing the leads don't seem to migrate much when it's sandwiched between the two implanted leads. Most of the patients we see have perc implants since the senior partners always did their own implants but I've done a few trial in patients with paddles as well and those are a little more challenging, more scar tissue around the paddle obviously.