Reimbursement Details

Our breathing pacemaker system is covered for reimbursement by most private and government insurance plans around the world. The equipment is sometimes indexed as a phrenic nerve pacemaker, diaphragm pacemaker, or electrophrenic respiration. A proforma invoice is available upon request.

Systems are available in a variety of configurations depending on the patient's needs. Additionally, custom components and conversions from other systems are also available. Please contact ABD for an appropriate price quotation.

ABD has compiled this coding information for your convenience. It is always the provider's responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services to be rendered. Please contact the patient's local carrier/payer for interpretation of appropriate coverage and coding policies.

Medicare Coverage

Phrenic nerve stimulation is covered for reimbursement under Medicare. Almost all state medical assistance programs and most private insurers use the Medicare guidelines to determine coverage. The relevant section of the Medicare National Coverage Determinations Manual reads as follows:

160.19 - Phrenic Nerve Stimulator
(Rev. 1, 10-03-03)
CIM 65-13

The implantation of a phrenic nerve stimulator is covered for selected patients with partial or complete respiratory insufficiency.

The phrenic nerve stimulator provides electrical stimulation of the patient's phrenic nerve to contract the diaphragm rhythmically and produce breathing in patients who have hypoventilation (a state in which an abnormally low amount of air enters the lungs). The device has been used successfully to treat hypoventilation caused by a variety of conditions, including respiratory paralysis resulting from lesions of the brain stem and cervical spinal cord and chronic pulmonary disease with ventilatory insufficiency. The phrenic nerve stimulator is intended to be an alternative to management of the patients with respiratory insufficiency who are dependent upon

However, an implanted phrenic nerve stimulator can be effective only if the patient has an intact phrenic nerve and diaphragm. Moreover, nerve injury may occur during the surgical procedure and if sufficient injury is incurred, the device will not prove useful to the patient. Consequently, it is possible for such a device to be indicated for a patient, but due to injury sustained during implant, fail to assist the patient, resulting in a return to the use of mechanical ventilation.

Cross reference to §160.7, "Electrical Nerve Stimulators."

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ICD-9 Codes

Common diagnosis codes for patients to be implanted with breathing pacemakers are as follows:

327.24	Idiopathic sleep related nonobstructive alveolar hypoventilation (sleep related hypoxia)
327.25	Congenital central alveolar hypoventilation syndrome
344.01	C1-C4, Complete quadriplegia
344.02	C1-C4, Partial quadriplegia
356.8	Other specified idiopathic peripheral neuropathy
519.4	Diaphragm paralysis
748.8	Congenital abnormalities of respiratory system

CPT Codes

The most commonly used CPT-4 codes for these procedures are as follows:

64577	Incision for implantation of neurostimulator electrodes, autonomic nerve
64590	Incision and subcutaneous placement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling
64595	Revision or removal of peripheral neurostimulator pulse generator or receiver

DRG Codes

The most commonly used DRG codes for these procedures are as follows:

75	Major chest procedures (ICD-9 CM 3485, Implant diaphragm pacemaker)
981,982,983	Extensive OR procedure unrelated to principal diagnosis

A summary of commonly billed codes is available for download as a PDF file by clicking here. Adobe Reader is required to view PDF files.

Reimbursement Details

Medicare Coverage

ICD-9 Codes

CPT Codes

DRG Codes

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