Get Interstim Billing Worksheet - Medtronic

Filling out the Interstim Billing Worksheet from Medtronic is essential for conveying necessary billing information related to the implantation of devices for urinary and bowel control. This guide provides a step-by-step approach to completing the form efficiently and accurately online.

Follow the steps to successfully complete the Interstim Billing Worksheet.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter patient details in the designated fields, including the patient's name, date, and time of the procedure.
3. Fill in the location and site of service to provide context for the billing.
4. Input the physician's name and obtain their signature in the appropriate fields to ensure authenticity.
5. Select the payer by indicating the insurance or payment source in the designated section.
6. Specify the procedure type by checking the appropriate box for either the PNE test, Stage I, Stage II, or full system implant as required.
7. Utilize the CPT codes section to enter the accurate codes corresponding to the procedures performed, ensuring to refer to the detailed list provided.
8. Complete the model numbers and device codes fields with the relevant information from the provided list to ensure proper identification of devices used.
9. In the total number of leads used section, indicate whether 1 or 2 leads were utilized during the procedure.
10. Review all entered information for accuracy before proceeding to save, download, print, or share the form.

Complete your documents online with confidence by following these steps.