Q: How do I code for implantation of a hypoglossal nerve stimulation system that includes placement of a chest wall sensor(s)?
In October 2020, the CPT Editorial Panel replaced three CPT Category III codes with three new CPT Category I codes to report open implantation, revision or replacement, and removal of hypoglossal nerve stimulator array. In addition, the CPT Editorial Panel made editorial revisions to codes 64568, 64569, 64570, 64575, 64580, and 64581.
A: 64582 Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array
This code is valued at a RVU of 16.00: recommended 35 minutes of pre-service evaluation time, 20 minutes of pre-service positioning time, 14 minutes of pre-service scrub/dress/wait time, 140 minutes of intra-service time, 20 minutes of immediate post-service time.
Included in this code is a discharge day management (99238) and two office visit(s) (2x 99213).
Additionally, DISE does need to be performed to determine candidacy for hypoglossal nerve stimulator services (HGN). However, if the physician performs both services, these elective procedures are often separated by months, given the difficulty of scheduling surgeries at sleep medicine practices, and are not done closely together.
It should be noted, the physician work for hypoglossal nerve stimulator services is different than vagus nerve work. Identifying and placing a nerve stimulator on the trunk of the vagus nerve is different than identifying and placing a nerve stimulator on the distal and wispy branches of the hypoglossal nerve. The physician must find the specific branch that protrudes the tongue and implant it. Additionally, the physician is putting other cranial nerve branches at risk where they dissect to find the hypoglossal nerve.
Standard 090-day global period direct practice expense inputs for CPT codes 64582, 64583 and 64584.
Q: How do I code for Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to an existing pulse generator?
A: 64583 Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to an existing pulse generator
This code is valued at a RVU of 16.50: recommended 20 minutes of pre-service positioning time, 14 minutes of pre-service scrub/dress/wait time, 150 minutes of intra-service time, 20 minutes of immediate post-service time.
Included in this code is a discharge day management (99238), and two office visit(s) (2x 99213).
Standard 090-day global period direct practice expense inputs for CPT codes 64582, 64583 and 64584.
Q: How do I code for removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array
A: 64584 Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array
This code is valued at a RVU of 14.00: recommended 40 minutes of pre-service evaluation time, 15 minutes of pre-service positioning time, 15 minutes of pre-service scrub/dress/wait time, 120 minutes of intra-service time, 20 minutes of immediate post-service time.
Included in this code is discharge day management (99238), and two office visit(s) (2x 99213).
Standard 090-day global period direct practice expense inputs for CPT codes 64582, 64583 and 64584.
Reviewed October 2023
