1. SCS: Indications Contraindications Medical Necessity
B. Todd Sitzman, MD, MPH
Hattiesburg, MS
SCS: Indications Contraindications Medical Necessity

2. Disclosures Cephalon - Consultant King Pharmaceuticals - Consultant
URL Pharma - Consultant
My relationships with the above corporate
entities should not bias the content of this
lecture handout or its presentation. All patient
care recommendations should be verified with
current scientific evidence and product labeling.

4. ICD-9: SCS Indications
= Failed back surgery syndrome (FBSS) or Postlaminectomy pain syndrome
= Lumbar or thoracic radiculopathy
= Cervical radicular pain syndrome or radiculopathy
= Causalgia of upper limb
= Causalgia of lower limb
= CRPS type I of upper limb
= CRPS type II of lower limb
= Epidural fibrosis
= Arachnoiditis or lumbar adhesive arachnoiditis
= Peripheral neuropathy of upper limb
= Peripheral neuropathy of lower limb

5. ICD-9: SCS Indications
= Mechanical complication of nervous system device implant or graft
= Infection or inflammatory reaction due to nervous system device implant and graft

6. SCS Contraindications
Medical -
Coagulopathy
Sepsis / recurrent MRSA infections
Psychiatric / Psychological -
Untreated, major comorbidity
Serious drug abuse/dependence
Inability to control SCS system / device
Secondary gain
Technical -
Demand cardiac pacemaker (special monitoring required)
Electromagnetic interference (MRI*, diathermy, electrocautery)
Hyperbaric pressures (diving below 10m water or > 2 atm)

7. Common CPT “Lead” Codes
= Percutaneous implantation of neurostimutor electrode array, epidural
= Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
= Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy
= Removal of electrode plate/paddle placed via laminotomy or laminectomy, including fluoroscopy
= Revision, including replacement, of spinal neurostimulator electrode percutaneous array, including fluoroscopy
= Revision, including replacement, of spinal neurostimulator electrode plate/paddle placed via laminotomy or laminectomy, including fluoroscopy

8. Common CPT “Generator” Codes
= Insertion or replacement of spinal neurostimulator pulse generator or receiver
= Revision or removal or implanted spinal neurostimulator pulse generator or receiver
= Electronic analysis of implanted neurostimulator pulse generator system, without reprogramming
= Electronic analysis of implanted neurostimulator pulse generator system, with intraoperative or subsequent programming, first hour
= Electronic analysis of implanted neurostimulator pulse generator system, with intraoperative or subsequent programming, each additional minutes after first hour

9. "intractable pain of the trunk and limbs"
CMS - Requirements
FDA Labeling
"intractable pain of the trunk and limbs"
CMS Reimbursement:
Other treatment modalities have been exhausted or judged to be unsuitable (Rx, surgical, physical,
psychological)
All facilities, equipment and personnel required for the proper diagnosis, treatment, and follow-up must be available
Permanent implantation must be preceded by a
temporary trial demonstrating pain relief

10. SCS Coverage and Authorization
Boston Scientific:
Medtronic:
St. Jude Medical:

11. Letter of Medical Necessity
- See LOMN example in syllabus -

15. B. Todd Sitzman, MD, MPH Hattiesburg, MS toddsitzman@msn.com
Thank You !
B. Todd Sitzman, MD, MPH Hattiesburg, MS