ELECTRICAL BONE GROWTH STIMULATION (EBGS) FOR NONUNION FRACTURES

A non-union fracture (733.82) is defined as a fracture that has not united within a minimum of 3 months of the original fracture.

Electrical stimulation of a non-united fracture is a procedure whereby electrodes are placed either at the fracture site (invasive) or around the fracture site (non-invasive) and electrical current is delivered to the fracture. In this manner, osteogenesis is promoted in a previously non-united fracture.

Electrical stimulation should be reported under code 20974 or 20975, as appropriate. Use of the device is included in the doctor's global allowance for the electrical stimulation (i.e., no separate payment can be made for the device).

However, if the patient employs the stimulator at home, rental or purchase of the device (code E0747) may be eligible for payment. In this instance, any charges reported by the doctor for electrical stimulation should be denied as not medically necessary.

For purposes of payment, re-casting is considered to be part of the global surgical allowance for the stimulation. Therefore, re-casting is not eligible for separate payment.
For ultrasound stimulation see Medical Policy Bulletin E-35.

EBGS AND SPINAL FUSION

Spinal fusion has been used to restore stability in a number of congenital, acquired, and degenerative spinal disorders. Failure to obtain spinal fusion has persisted over the years as a relatively common problem.

Electrical bone growth stimulation (EBGS) of the spine is a procedure which promotes the healing process by applying a direct electrical current to the spine. EBGS is utilized for patients at high risk for pseudoarthrosis. High risk factors include: previous failed fusion, multilevel fusion, and grade II or worse spondylolisthesis. This process can be performed as an invasive or noninvasive procedure, depending on the needs of the patient.

Invasive EBGS of the spine involves the insertion of a bone stimulation device directly into the area of spinal surgery after the fusion procedure has been completed. Invasive EBGS of the spine should be reported under code 20975 and processed in accordance with multiple surgery payment guidelines.

Noninvasive EBGS of the spine is a procedure which involves the use of an external power supply and externally applied coils which generate a current through the site where bone growth is desired. As an adjunct to spinal fusion surgery, noninvasive EBGS can begin within 30 days after the most recent lumbar fusion procedure. As a nonsurgical salvage for pseudoarthrosis, EBGS can be applied after a minimum of 6 months (after surgery) has passed. Noninvasive EBGS of the spine should be reported under code 20974.

However, if the patient employees the stimulator at home, rental or purchase of the device (code E0748) may be eligible for payment. In this instance, any charges reported by the doctor for EBGS of the spine should be denied as not medically necessary.