Urgent Call to Action: Billing/Coding for PNS Trials and Implants...

[drusso]

All Pain MD's need to rally around this...Urgent action required NOW.


To whom it may concern

Subject: StimQ PNS Implant Procedures (Vendor: Stimwave)

The American Hospital Association has determined that the appropriate code assignment for StimQ PNS stimulator implant is 64555. Furthermore, they specifically stipulated that it is not appropriate to report CPT code 64590 (Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling) for this procedure. This latest coding guidance for this procedure results in the following:

1. We will immediately adhere to the new coding guideline issued by AHA; all StimQ PNS procedures will be coded as a 64555.

2. Reimbursement for permanent implantation of the system is reduced from an average of $22, 000 to $7, 200

3. Performing this procedure results in a net loss; the cost of the implant is $10,000 more than the total reimbursement

As you can see from the above, this unfortunate change in the coding guidance is making it unviable for the facility to continue to perform these procedures.

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Members don't see this ad.

 

[lobelsteve]

PNS is 99% a scam.

 

[drusso]

PNS is 99% a scam.

Can you elaborate?

 

[lobelsteve]

Can you elaborate?

Nope.

 

[Orin]

All Pain MD's need to rally around this...Urgent action required NOW.


To whom it may concern

Subject: StimQ PNS Implant Procedures (Vendor: Stimwave)

The American Hospital Association has determined that the appropriate code assignment for StimQ PNS stimulator implant is 64555. Furthermore, they specifically stipulated that it is not appropriate to report CPT code 64590 (Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling) for this procedure. This latest coding guidance for this procedure results in the following:

1. We will immediately adhere to the new coding guideline issued by AHA; all StimQ PNS procedures will be coded as a 64555.

2. Reimbursement for permanent implantation of the system is reduced from an average of $22, 000 to $7, 200

3. Performing this procedure results in a net loss; the cost of the implant is $10,000 more than the total reimbursement

As you can see from the above, this unfortunate change in the coding guidance is making it unviable for the facility to continue to perform these procedures.

I have seen this but it makes absolutely no sense to me why the AHA is pushing this line of clarity when the Stimwave system is the only of the companies that can code for 64590 or 63685.

Do they feel Stimwave's SCS system does not qualify for 63685 as well?

I assume they'll feel similarly about the Nalu system?

I also haven't seen it officially from the AHA, but their website doesn't seem to be easy to search.

 

[SSdoc33]

Nope.

Remember, it doesnt matter if its a scam, we all have to be in this together.

Like SIJ fusion

 

[sloh]

Remember, it doesnt matter if its a scam, we all have to be in this together.

Like SIJ fusion

It's not about the data. It's about freedom!

 

[BobBarker]

Nalu has a tiny IPG so should be fine.

 

[Orin]

Nalu has a tiny IPG so should be fine.

That's BS. Nalu has no ability to generate a pulse without the external device. That's no different than the Stimwave setup other than the Stimwave coupling system is integrated into the lead whereas the Nalu system requires you have to option to attach it.

Calling it an "Implantable Pulse Generator" does not make it so.

https://www.accessdata.fda.gov/cdrh_docs/pdf18/K183047.pdf

Table 2, page 10 of the PDF for Nalu's comparison

 

[DesertDoc16]

Where did this come from? I can’t find anything on AHA

 

[drusso]

That's BS. Nalu has no ability to generate a pulse without the external device. That's no different than the Stimwave setup other than the Stimwave coupling system is integrated into the lead whereas the Nalu system requires you have to option to attach it.

Calling it an "Implantable Pulse Generator" does not make it so.

https://www.accessdata.fda.gov/cdrh_docs/pdf18/K183047.pdf

Table 2, page 10 of the PDF for Nalu's comparison

If the patient comes back after implant and needs another disc can you bill for another IPG?

 

[drusso]

Nope.

You can't argue with this?

A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions - Bioelectronic Medicine

Background Peripheral Nerve Stimulation has been used to treat human disease including pain for several decades. Innovation has made it a more viable option for treatment of common chronic pain processes, and interest in the therapy is increasing. Main body While clinical data is forthcoming...

bioelecmed.biomedcentral.com

Neurostimulation for Intractable Chronic Pain

The field of neuromodulation has seen unprecedented growth over the course of the last decade with novel waveforms, hardware advancements, and novel chronic pain indications. We present here an updated review on spinal cord stimulation, dorsal root ganglion ...

www.ncbi.nlm.nih.gov

Peripherally Induced Reconditioning of the CNS | JPR

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain

www.dovepress.com

 

[lobelsteve]

You can't argue with this?

A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions - Bioelectronic Medicine

Background Peripheral Nerve Stimulation has been used to treat human disease including pain for several decades. Innovation has made it a more viable option for treatment of common chronic pain processes, and interest in the therapy is increasing. Main body While clinical data is forthcoming...

bioelecmed.biomedcentral.com

Neurostimulation for Intractable Chronic Pain

The field of neuromodulation has seen unprecedented growth over the course of the last decade with novel waveforms, hardware advancements, and novel chronic pain indications. We present here an updated review on spinal cord stimulation, dorsal root ganglion ...

www.ncbi.nlm.nih.gov

Peripherally Induced Reconditioning of the CNS | JPR

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain

www.dovepress.com

Paid advertisements.

 

[Ducttape]

did you really post 3 articles all by the same physician?



what does your other thought leader Centeno think about stimwave? your past posts suggest that he wont defend SIJ fusion...

 

[SSdoc33]

drusso has officially jumped the shark, like this old avatar. he was teetering for a while, but he is officially there now.

 

[drusso]

Remember, it doesnt matter if its a scam, we all have to be in this together.

Like SIJ fusion

https://www.painmedicinenews.com/Multimedia/Article/04-21/ON-PAIN-Dosing-Electricity-With-Peripheral-Nerve-Stimulation/63187?sub=D583B2492B5C3384375D7535C70306FFEA2FA5FE72262844BD56FD3F46071&enl=true&dgid=&utm_source=enl&utm_content=1&utm_campaign=20210419&utm_medium=button

 

[drusso]

did you really post 3 articles all by the same physician?



what does your other thought leader Centeno think about stimwave? your past posts suggest that he wont defend SIJ fusion...

 

[drusso]

drusso has officially jumped the shark, like this old avatar. he was teetering for a while, but he is officially there now.

I've updated my avatar to reflect your sentiments...

 

[Ducttape]

I am thankful that you posted from someone other than Timothy Deer and Chris Centeno.

 

[drusso]

Paid advertisements.

 

[lobelsteve]

View attachment 335454

I will read it. N too low. Not applicable to my patients. How do you placebo a wire? Some of the authors responsible for death of Pain.

 

[drusso]

drusso has officially jumped the shark, like this old avatar. he was teetering for a while, but he is officially there now.

Game changer...

Multi-center Study Demonstrates Significant Reductions in Postoperative Pain and Opioid Use Following Peripheral Nerve Stimulation Treatment

– Findings Published as Congress Demands Review of Medicare Coverage for Non-opioid Treatments – Cleveland, Ohio- April 26, 2021- Results of a multicenter

www.sprtherapeutics.com

 

[lobelsteve]

Game changer...

Multi-center Study Demonstrates Significant Reductions in Postoperative Pain and Opioid Use Following Peripheral Nerve Stimulation Treatment

– Findings Published as Congress Demands Review of Medicare Coverage for Non-opioid Treatments – Cleveland, Ohio- April 26, 2021- Results of a multicenter

www.sprtherapeutics.com

This is the commercial from the company’s website. Not useful info.

 

[Agast]

The cost of the Stimwave implant appears to be inflated in proportion to what they thought they could milk out of insurance TBH. I don't see why it should even cost $10,000.

3. Performing this procedure results in a net loss; the cost of the implant is $10,000 more than the total reimbursement

 

[drusso]

This is the commercial from the company’s website. Not useful info.

You're such a Debbie-Downer...

 

[drusso]

The cost of the Stimwave implant appears to be inflated in proportion to what they thought they could milk out of insurance TBH. I don't see why it should even cost $10,000.

3. Performing this procedure results in a net loss; the cost of the implant is $10,000 more than the total reimbursement

 

[SSdoc33]

View attachment 335673

WTF is functional instability of the lumbar spine? seems like a crock of sh$t.

 

[callmeanesthesia]

WTF is functional instability of the lumbar spine? seems like a crock of sh$t.

I think it means their back hurts a lot but their imaging looks fine.

 

[SSdoc33]

I think it means their back hurts a lot but their imaging looks fine.

 

[Agast]

WTF is functional instability of the lumbar spine? seems like a crock of sh$t.

Functional instability sounds like a great way to describe some of my patients...

 

[Orin]

There's a lot of snake oil out there to try, but at the end of the day, it's what we've got to work with from an evidence-based management perspective when patients have failed the less invasive therapies. I'd rather do PNS all day than send some of these folks for their 3 or 4th surgery for a pain complaint.

 

[Taus]

WTF is functional instability of the lumbar spine? seems like a crock of sh$t.

It’s the reason to inject everything in the “functional spinal unit” w stem cells..... I watched some of those procedure videos. It felt like I was watching a Frank’s red hot commercial.... “ I put that $hit on everything!”

 

[drusso]

 

[callmeanesthesia]

View attachment 336652

This is the kind of thing we are urgently protecting?

 

[drusso]

This is the kind of thing we are urgently protecting?

I think it's opioid-sparing technology.

 

[deleted875186]

Not sure where the hate comes from. I think the PNS devices work. We act like most of the SCS studies are not backed by industry.

not sure why we are poo pooing the sprint study published in anesthesiology, seems like a good motor sparing perioperative pain control strategy, would not be surprised if sprint focused on selling their unit as a peri operative device and lowered the cost.

 

[drusso]

Not sure where the hate comes from. I think the PNS devices work. We act like most of the SCS studies are not backed by industry.

not sure why we are poo pooing the sprint study published in anesthesiology, seems like a good motor sparing perioperative pain control strategy, would not be surprised if sprint focused on selling their unit as a peri operative device and lowered the cost.

https://www.painmedicinenews.com/Multimedia/Article/04-21/ON-PAIN-Dosing-Electricity-With-Peripheral-Nerve-Stimulation/63187?sub=4FE5548A6F1583D7C5B6291EC18A4AA693E4AF364B6C93082B2D9B23F14DE29&utm_medium=social

 

[lobelsteve]

Internal tens for profit.

 

[Ducttape]

Not sure where the hate comes from. I think the PNS devices work. We act like most of the SCS studies are not backed by industry.

not sure why we are poo pooing the sprint study published in anesthesiology, seems like a good motor sparing perioperative pain control strategy, would not be surprised if sprint focused on selling their unit as a peri operative device and lowered the cost.

there is a marked difference between perioperative use and long term use, as there is a marked difference between acute and chronic pain. different mechanisms, different effects.

https://www.painmedicinenews.com/Multimedia/Article/04-21/ON-PAIN-Dosing-Electricity-With-Peripheral-Nerve-Stimulation/63187?sub=4FE5548A6F1583D7C5B6291EC18A4AA693E4AF364B6C93082B2D9B23F14DE29&utm_medium=social

1. salesman
2. how much botox has he had?

 

[Orin]

Internal tens for profit.

You're thinking of the Reactiv-8 product. This is percutaneous TENS.

there is a marked difference between perioperative use and long term use, as there is a marked difference between acute and chronic pain. different mechanisms, different effects.

1. salesman
2. how much botox has he had?

Although he is very commercialized, I don't fault him for doing it well.

I would argue though that the acute and chronic mechanisms have a significant degree of overlap mechanistically, with most preclinical work suggesting blocking acute changes can help reduce the magnitude of chronic changes. I'd rather see things going this way, from chronic treatment to acute, as compared to opioids where they went from an acute therapy and used it in the chronic setting. With that said, I think their data are stronger for the chronic therapy than an acute device, especially as they have a definite non-responder rate.