Local Coverage Article Response to Comments

Response to Comments: Spinal Cord Stimulators for Chronic Pain


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Article ID
Article Title
Response to Comments: Spinal Cord Stimulators for Chronic Pain
Article Type
Response to Comments
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Article Text
Noridian's Response to Provider Recommendations (for comment period ending 08/10/2015):

Response To Comments

1One commentator felt the policy was too narrow with too many limitations and felt it was “a caring view of what could be the last gasp for people in dire need. However no specific suggestions or codes were indicated.
2Several suggestions were made to not limit the number of contacts on any lead and that the limitation to 16 contacts is restrictive. It was stated that wider leads and more contacts should be allowed. Although we will not immediately change this limitation, additional leads can be added on appeal, and we will monitor how frequently this happens for possible increase over time. More than 16 contacts will be available on appeal. We also understand that some manufacturers may develop leads with more than 16 contacts; and we would allow those if FDA approved.
3One comment from a pain center addressed our recommendation that, when the physician implanting the permanent stimulator is different from the physician putting in the trial stimulator, the patient must be made aware of the different physician. Although we understand this may take a brief explanation, we feel for transparency to the patient, that the patient should know who will be performing any aspect of their care. We are not asking for attestations, but for information that the patient who chooses the physician to perform the stimulator trial should know that another physician may be involved with the permanent stimulator-if the temporary trial is to lead to a permanent spinal cord stimulator.
4One commenter noted the policy had not only the initial spinal cord stimulator insertion codes, but also the subsequent revision/removal codes (63661 – 63665 and 63668). Reasons for replacement include slippage, malfunction, malposition, etc. Battery replacement occurs when the battery fails and the neurostimulator must be removed from implantation to repair / replace the battery. This commentator also asked for additional ICD-10-CM codes. Those additional ICD-10-CM codes that we felt were appropriate (and not very unspecified in ICD-10-CM –a coding system that is more specific to disease and laterality) are being added to the final policy, but we did not add very unspecified codes when the physician should know and use the more specific codes that are already in the policy.
5Another group of specialty societies wanted additional electrode contacts beyond 16. They asked we change language from “a last resort” to “a late (if not last) resort”. They also recommended we change language for code 63655 from “one spinal cord stimulator per lifetime” to “one spinal cord stimulator per spinal region per lifetime”. Additional leads or electrodes can be accepted on appeal as noted in Response 2. We will monitor how often higher number of electrodes are used and possibly amend the policy at that time. Noridian will change the language to from “a last resort” to “a late (if not last) resort”. Noridian will not change the language requested for CPT code 63655; however, unusual situations may be appealed.
6Other commenters requested additional ICD-10-CM codes. These requested ICD-10-CM codes are not appropriate in general, but individual rare situations are always appealable.

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  • Spinal
  • cord
  • Stimulators