St. Jude Medical provides this reference for information purposes only. This reference does not serve as reimbursement or legal advice, nor is it intended to increase payment by any payor. Nothing in this reference guarantees that the levels of reimbursement, payment, or charges are accurate or that reimbursement will be received. The physician or provider is responsible for obtaining reimbursement and for verifying the accuracy and veracity of all claims submitted to third-party payors. Laws, regulations, and coverage policies are complex and updated frequently, and therefore physicians and providers should consult their local carriers, administrative contractors, or a reimbursement specialist with reimbursement or billing questions. This document is intended to provide reimbursement assistance only where products have been used according to their FDA-approved or cleared indications. Where reimbursement is being requested in conjunction with use of a product that is inconsistent with, or not expressly granted in, the FDA-approved labeling (which may be found in the clinician s manual, user s guide or directions for use), please consult your billing personnel or the payor for instructions on the proper handling of this type of claim. Some payors may restrict such claims or services. Contact your Medicare contractor or other payor for any questions regarding coverage, coding and payment. On October 1, 2014, the ICD-9-CM code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10-CM code sets. The transition to ICD-10-CM is occurring because ICD-9-CM produces limited data about patients medical conditions and hospital inpatient procedures. ICD-9-CM is currently 30 years old, has outdated terms, and is inconsistent with current medical practice. The structure of ICD-9-CM limits the number of new codes that can be created, and many ICD-9-CM categories are full and have no room for expansion. The table below highlights the differences in ICD-9-CM and ICD-10-CM and the major reasons for the transition. ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes 3 5 characters in length 3 7 characters in length Approximately 14,025 codes First digit may be alpha (e or v) or numeric. Digits 2 5 are numeric Limited space for new codes Lack detail Lack laterality Difficult to analyze data due to non-specific codes Approximately 69,125 codes Digit 1 is alpha; digits 2 and 3 are numeric; digits 4 7 are alpha or numeric Flexible for adding new codes Very specific Have laterality Specificity improves coding accuracy and depth of data for analysis ICD-10-CM will affect diagnosis coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. Everyone covered by HIPAA must also switch to Version 5010 transaction standards. The change to ICD-10-CM does not affect CPT coding for outpatient procedures. ICD-10-CM diagnosis codes must be used for all healthcare services provided in the U.S. on or after October 1, 2014. Claims with ICD-9-CM codes for services provided on or after October 1, 2014, will not be paid. All ICD-10-CM books are still in draft form. The following is a crosswalk from the ICD-9-CM diagnosis codes for spinal cord stimulation to their current ICD-10-CM counterparts. For more information about the ICD-10-CM transition and tips on implementation, please refer to the websites below. http://www.aapc.com/icd-10/ http://www.who.int/classifications/icd/en/ https://www.cms.gov/icd10/
Primary Diagnosis Codes 338.21 G89.21 Chronic pain due to trauma 338.28 G89.28 Other chronic postprocedural pain 338.4 G89.4 Chronic pain syndrome 053.12 B02.22 Postherpetic trigeminal neuralgia 053.19 B02.29 Other postherpetic nervous system involvement 322.9 G03.9 Meningitis, unspecified 337.21 G90.519 Complex regional pain syndrome I of unspecified upper limb 337.22 G90.529 Complex regional pain syndrome I of unspecified lower limb 337.29 G90.59 Complex regional pain syndrome I of other specified site 353.0 G54.0 Brachial plexus disorders 353.1 G54.1 Lumbosacral plexus disorders 353.6 G54.6 Phantom limb syndrome with pain 353.8 G54.8 Other nerve root and plexus disorders 354.4 G56.40 Causalgia of unspecified upper limb 354.8 G56.80 Other specified mononeuropathies of unspecified upper limb 354.9 G56.90 Unspecified mononeuropathy of unspecified upper limb 355.71 G57.70 Causalgia of unspecified lower limb 355.79 G57.80 Other specified mononeuropathies of unspecified lower limb 355.8 G57.90 Unspecified mononeuropathy of unspecified lower limb 440.22 I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity 722.81 722.82 722.83 M96.1 M54.12 Postlaminectomy syndrome, not elsewhere classified Radiculopathy, cervical region 723.4 M54.13 Radiculopathy, cervicothoracic region 724.3 M54.30 Sciatica, unspecified side M54.14 Radiculopathy, thoracic region M54.15 Radiculopathy, thoracolumbar region 724.4 M54.16 Radiculopathy, lumbar region M54.17 Radiculopathy, lumbosacral region
952.00 952.01 952.02 952.03 952.04 952.05 952.06 952.07 952.08 S14.101A S14.102A S14.103A S14.104A S14.111A S14.112A S14.113A S14.114A S14.131A S14.132A S14.133A S14.134A S14.121A S14.122A S14.123A S14.124A S14.151A S14.152A S14.153A S14.154A S14.105A S14.106A S14.107A S14.108A S14.115A S14.116A S14.117A S14.118A S14.135A S14.136A S14.137A S14.138A S14.125A S14.126A S14.127A S14.128A Unspecified injury at C1 level of cervical spinal cord, initial encounter Unspecified injury at C2 level of cervical spinal cord, initial encounter Unspecified injury at C3 level of cervical spinal cord, initial encounter Unspecified injury at C4 level of cervical spinal cord, initial encounter Complete lesion at C1 level of cervical spinal cord, initial encounter Complete lesion at C2 level of cervical spinal cord, initial encounter Complete lesion at C3 level of cervical spinal cord, initial encounter Complete lesion at C4 level of cervical spinal cord, initial encounter Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter Central cord syndrome at C1 level of cervical spinal cord, initial encounter Central cord syndrome at C2 level of cervical spinal cord, initial encounter Central cord syndrome at C3 level of cervical spinal cord, initial encounter Central cord syndrome at C4 level of cervical spinal cord, initial encounter Other incomplete lesion at C1 level of cervical spinal cord, initial encounter Other incomplete lesion at C2 level of cervical spinal cord, initial encounter Other incomplete lesion at C3 level of cervical spinal cord, initial encounter Other incomplete lesion at C4 level of cervical spinal cord, initial encounter Unspecified injury at C5 level of cervical spinal cord, initial encounter Unspecified injury at C6 level of cervical spinal cord, initial encounter Unspecified injury at C7 level of cervical spinal cord, initial encounter Unspecified injury at C8 level of cervical spinal cord, initial encounter Complete lesion at C5 level of cervical spinal cord, initial encounter Complete lesion at C6 level of cervical spinal cord, initial encounter Complete lesion at C7 level of cervical spinal cord, initial encounter Complete lesion at C8 level of cervical spinal cord, initial encounter Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter Anterior cord syndrome at C8 level of cervical spinal cord, initial encounter Central cord syndrome at C5 level of cervical spinal cord, initial encounter Central cord syndrome at C6 level of cervical spinal cord, initial encounter Central cord syndrome at C7 level of cervical spinal cord, initial encounter Central cord syndrome at C8 level of cervical spinal cord, initial encounter
952.09 952.10 952.11 952.12 952.13 952.14 952.15 952.16 952.17 952.18 952.19 S14.155A S14.156A S14.157A S14.158A S24.101A S24.102A S24.111A S24.112A S24.131A S24.141A S24.151A S24.152A S24.151A S24.152A S24.103A S24.104A S24.113A S24.114A S24.133A S24.134A S24.153A S24.154A S24.153A S24.154A Other incomplete lesion at C5 level of cervical spinal cord, initial encounter Other incomplete lesion at C6 level of cervical spinal cord, initial encounter Other incomplete lesion at C7 level of cervical spinal cord, initial encounter Other incomplete lesion at C8 level of cervical spinal cord, initial encounter Unspecified injury at T1 level of thoracic spinal cord, initial encounter Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter Complete lesion at T1 level of thoracic spinal cord, initial encounter Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter 952.2 S34.109A Unspecified injury to unspecified level of lumbar spinal cord, initial encounter 952.3 S34.139A Unspecified injury to sacral spinal cord, initial encounter 952.4 S34.3XXA Injury of cauda equina, initial encounter 952.8 S34.139A Unspecified injury to sacral spinal cord, initial encounter 952.9 S14.109A S24.109A S34.109A S34.139A Unspecified injury at unspecified level of cervical spinal cord, initial encounter Unspecified injury at unspecified level of thoracic spinal cord, initial encounter Unspecified injury to unspecified level of lumbar spinal cord, initial encounter Unspecified injury to sacral spinal cord, initial encounter 953.0 S14.2XXA Injury of nerve root of cervical spine, initial encounter 953.1 S24.2XXA Injury of nerve root of thoracic spine, initial encounter 953.2 S34.21XA Injury of nerve root of lumbar spine, initial encounter 953.3 S34.22XA Injury of nerve root of sacral spine, initial encounter
953.4 S14.3XXA Injury of brachial plexus, initial encounter 953.5 S34.4XXA Injury of lumbosacral plexus, initial encounter 953.8 953.9 S14.2XXA S24.2XXA S34.21XA S34.22XA S34.4XXA S14.2XXA S24.2XXA S34.21XA S34.22XA S34.4XXA Injury of nerve root of cervical spine, initial encounter Injury of nerve root of thoracic spine, initial encounter Injury of nerve root of lumbar spine, initial encounter Injury of nerve root of sacral spine, initial encounter Injury of lumbosacral plexus, initial encounter Injury of nerve root of cervical spine, initial encounter Injury of nerve root of thoracic spine, initial encounter Injury of nerve root of lumbar spine, initial encounter Injury of nerve root of sacral spine, initial encounter Injury of lumbosacral plexus, initial encounter St. Jude Medical Inc. Global Headquarters One St. Jude Medical Drive St. Paul, Minnesota 55117 USA +1 651 756 2000 +1 651 756 3301 Fax St. Jude Medical S.C., Inc. U.S. Division 6300 Bee Cave Road Bldg. Two, Suite 100 Austin, TX 78746 USA +1 512 732 7400 +1 512 732 2418 Fax SJMprofessional.com Unless otherwise noted, indicates that the name is a trademark of, or licensed to, St. Jude Medical or one of its subsidiaries. ST. JUDE MEDICAL and the nine-squares symbol are trademarks and service marks of St. Jude Medical, Inc. and its related companies. 2014 St. Jude Medical, Inc. All Rights Reserved. US-2000317 A EN (03/14)