An unresolved error in some HCPCS code manuals has prolonged confusion over proper reporting and payment of L8680 Implantable neurostimulator electrode, each. To ensure complete reimbursement, review claims going back to Jan. 1, 2010 — and keep watching claims for at least the rest of 2011.

Wrong descriptor in print
A neurostimulator assembly consists of a pulse generator or receiver (a power source) and 1 or more electrode arrays, also called leads. Each array typically includes multiple electrodes. In 2009, 1 unit of L8680 was billed for each electrode, or contact point. For example, a single array with 4 electrodes would be reported as L8680 x 4.

In November 2009, CMS released the 2010 Alpha-Numeric HCPCS file with a revised long descriptor for L8680, which specified Implantable neurostimulator electrode (with any number of contact points), each. The phrase "with any number of contact points" now meant that an array with 4 electrodes would be reported as L8680 x 1, rather than as L8680 x 4, as had been the case.

A short time later, in response to physician specialty organization and medical device manufacturer inquiries, CMS announced that effective Jan. 1, 2010, the long descriptor for L8680 would revert to Implantable neurostimulator electrode, each. In other words, the descriptor wouldn't change from 2009, and the code would be applied just as it had been. For example, 2 arrays, each with 4 electrodes, would be reported as L8680 x 8 (not L8680 x 2).

Unfortunately, the 2010 HCPCS Correction file (www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp), which properly listed the descriptor for L8680 as Implantable neurostimulator electrode, each, was released after many 2010 HCPCS codebooks had gone to press. More unfortunate still, several versions of the HCPCS manual repeated the error for 2011, and continue to include the retracted "any number of contact points" descriptor.

Review your EOBs for L8680
While the incorrect descriptor remains in print, providers and payors alike risk assigning L8680 in error. Correct coding and reimbursement require that you report a single unit of L8680 for each implanted electrode (contact point). Review your EOBs for L8680 claims going back to Jan. 1, 2010, to be sure those claims were processed and paid correctly, and apply the code appropriately going forward.

Hospitals and ASCs may use L8680 to report outpatient services to non-Medicare payors (verify individual payor policies). Medicare doesn't allow separate payment for implanted neurostimulator devices in the ASC because the surgical procedure codes are considered to be device-intensive procedures, and the implants are included in reimbursement for the surgical procedure. Outpatient hospitals must use C-codes when reporting devices to Medicare. In a hospital outpatient setting, report a neurostimulator lead using C1778 Lead, neurostimulator (implantable). HCPCS C1778 is reimbursed per lead (array), rather than by electrode. For example, a single array with 4 contact points would be reported as C1778 x 1.