AHA Coding Clinic® for HCPCS - 2025 Issue 4; Ask the Editor

Implantation of Hypoglossal Nerve Stimulator System

The patient presented for implantation of a hypoglossal nerve stimulator. The manufacturer has advised that this system integrates the respiratory sensing directly into the implantable pulse generator, eliminating the need for a separate sensing lead.An incision was made in the right upper neck below the mandible. Dissection was carried down through the subcutaneous tissue into the digastric triangle. The posterior border of the mylohyoid muscle was freed up and retracted anteriorly. The hypoglossal nerve and superior/posterior branches innervating the hyoglossus muscle were identified. The cuff electrode for the hypoglossal nerve stimulator was placed distally to these branches innervating genioglossus, transverse, and vertical muscles. The C1 branch was also identified and included in the cuff. The stimulation lead was anchored to the digastric tendon using two sutures.A second incision was made in the right upper chest lateral to the sternal margin. Dissection was carried down through the skin and subcutaneous tissue to the fascia of the pectoralis muscle. An inferior pocket for the generator was created deep to the subcutaneous layer and superficial to the fascia of the pectoralis muscle. The stimulation lead was then tunneled into a subplatysmal plane with blunt dissection and brought out into the sub-clavicular pocket where the stimulation lead was connected to the implantable pulse generator. Diagnostic evaluation confirmed good placement of the stimulation cuff as demonstrated by activation of the genioglossus and transverse and vertical muscles, resulting in unhindered, stiffened tongue protrusion, confirmed visually. Diagnostic evaluation also confirmed functionality of respiratory sensing with good rise and fall associated with patient respirations.We proceeded with interrogation and programming of the device. Bilateral tongue protrusion was seen with excellent functional movement of the tongue and no stimulation noted in the exclusion channel on the NIM. The device was then programmed.What is the correct CPT code to report implantation of this hypoglossal nerve stimulator generator with stimulation lead and cuff, but without a separate respiratory sensing electrode? ...

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