Health data standards and systems

Our hospital has recently begun performing sacral modulation for faecal incontinence and we are unsure how to code this. This procedure is done in
two phases. The first phase involves having electrodes implanted in the sacral nerves in a day surgery procedure which are later connected to an
external pulse generator. The second phase involves the implantation of a pacemaker about the size of a cigarette lighter, in the upper back or lower abdomen. The patient contols the pacemaker with an activator, thus enabling bowel control.

We feel that the appropriate codes for this procedure are:
Phase 1:
39130-00 Percutaneous insertion of epidural electrodes
Percutaneous:
• burying }
• replacement}
• revision} of epidural electrodes
• threading}
• tunneling }
Includes: trial of dorsal column stimulator
Excludes: that with subcutaneous implantation of spinal neurostimulator device (39130-01 [43])


Phase 2:
39134-00 Subcutaneous implantation of spinal neurostimulator device/receiver
Replacement of subcutaneous spinal neurostimulator device
Revision of subcutaneous spinal neurostimulator device
Subcutaneous implantation of:
• spinal pulse generator
• spinal radiofrequency (emitting) device/receiver
Excludes: that with insertion of epidural electrodes (39130-01, 39139-01 [43])

With a diagnosis code of R15 Faecal Incontinence, this groups to a 901Z.
However, there is a code for Insertion of anal electrode at 32206-00 [929] which may be more appropriate.

This query was referred the NCCH who provided the following advice:
The NCCH supports the codes selected by the enquirer for the case cited. However, clinical advice states that phase 1 (implantation of electrodes into sacral nerves) may be performed as an 'open' procedure. If documentation indicates that phase one is an open procedure, assign:
39139-00 [43] Insertion epidural electrodes by laminectomy

MBS contains item numbers that may be more appropriate for this procedure. NCCH will consider adding them to a future edition of ACHI.

The NCCH and clinical advice support the assignment of K59.2 'Neurogenic bowel, not elsewhere classified' for documentation of 'neuropathic faecal incontinence'.


There is an index error at Insertion, electrode, anal, directing coders to assign: 32206 00 [929] Insertion of gracilis neosphincter pacemaker. This code is actually in Block [940]. The NCCH is aware of this and has amended it in fifth edition.