# Pain Management Coding - Help



## Noelle1965 (Jan 6, 2012)

Hi! I'm very new to pain management coding and wanted to find out if I'm on the right track....

Can someone please tell me how they would code the following for a physician at a surgery center (don't need the surgery center coding, just the physician)

Percutaneous Supraorbital Trial Peripheral Nerve Stimulator, Cervical Spinal Cord Stimulator, Intra-operative Programming.


Thanks very much!


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## dwaldman (Jan 8, 2012)

Percutaneous Supraorbital Trial Peripheral Nerve Stimulator, Cervical Spinal Cord Stimulator, Intra-operative Programming.

63650 for the cervical spinal cord stimulator trial, and I believe  for supraorbital nerve stimulation, this would fall under 64555.


For April 2011 CPT Assistant as seen below, it was stated that since 95972 states first hour, time guidelines apply and that programming that is less than 31 minutes should be reported with the 52 modifier reduced services. The fact that 95971/95972 have in their code descriptors, the following: "Electronic analysis of implanted neurostimulator pulse generator system" the question arises when a trial is performed, the pulse generator is not implanted in this case, below they describe: "when only impedance testing and stimulation is performed to verify function of the leads (not the pulse generator)". In this article that state simple versus complex was depending the device capabilities of 3 or fewer for 95971 and more than three with 95972 in regards to: "pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time (stimulation parameters changing in time periods of minutes including dose lockout times), more than one clinical feature (eg, rigidity, dyskinesia, tremor). "

In 2012 AMA CPT changes, it states: "Changes have also been made to the nurostimulation codes throughout the CPT codebook to provide parallel language for these procedures as well as to more clearly portray the intended use for these procedures. This includes clarifciations for guidelines to differentiate "simple" versu "complex" programming procedures, identifying three or fewer parameters for simple versus four or more for complex procedures. There have also been changes to instruct users to append modifier 52 to services for sessions lasting less than 31 minutes in duration"

The documentation would have to support the physician performed the programming, the duration of the programming, and the number of parameters that were involved in the programming to determine the code selection, the modifier if needed, or not to report for situations when the manufacturer's rep is providing the service.

April 2011 CPT Assistant

Question 3: May code 95972 be reported for complex programming of an external nonimplanted neurostimulator pulse generator that is attached to a temporary electrode array? 

AMA Response: Correct choice of programming codes is not based upon the intent of the stimulator lead array being used as a "temporary" external lead or as a "permanent" implanted lead. An inherent portion of the lead placement, and is not additionally reported using either code 95971 or 95972, is electronic analysis during a percutaneous electrode array placement (63650) or during a laminectomy for implantation of a plate/paddle electrode array (63655) when only impedance testing and stimulation is performed to verify function of the leads (not the pulse generator). 

Codes 63650-63688 apply to both simple and complex neurostimulators. Therefore, codes 95970-95975 are reported for initial or subsequent electronic analysis and programming of neurostimulator pulse generators. The guidance to determine electronic analysis of an implanted simple versus complex neurostimulator as specified in the CPT guidelines is based upon device capability, as reflected in either neurostimulator programming code 95971, Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, or code 95972, Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour. 

As stated in the CPT guidelines, code 95971 describes intraoperative or subsequent electronic analysis of an implanted simple spinal cord or peripheral (ie, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator system with programming. Codes 95972 and 95973 describe intraoperative (at initial insertion/ revision) or subsequent electronic analysis of an implanted complex spinal cord or peripheral (except cranial nerve) neurostimulator pulse generator system, with programming. 

A simple neurostimulator pulse generator/transmitter (codes 95970, 95971) is one capable of affecting three or fewer of the following: pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time (stimulation parameters changing in time periods of minutes including dose lockout times), more than one clinical feature (eg, rigidity, dyskinesia, tremor). A complex neurostimulator pulse generator/ transmitter (codes 95970, 95972-95975) is one capable of affecting more than three of the above. Modifier 52, Reduced Services, should be appended to code 95972 in the event the duration of the services was performed in less than 31 minutes


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## Noelle1965 (Jan 9, 2012)

*Thank you and ONE more question *

Thank you so much I appreciate your response very much!!

I do have ONE more question....as all of a sudden they are sending me operative reports....I did go through a pain management coding course, but it wasn't very in-depth and unfortunately there is not a lot of information "out there"..

If you have:  Percutaneous Supraorbital and Greater Occipital Trial Peripheral Nerve Stimulator Bilaterally, Intra-Operative Programming (Octrode lead placed bilaterally) AND (St. Jude Quad lead placed for the Occipital).

I have 64555 x2 (50 ) modifier
63650
63650 - 51
63650 - 51
95971

Does this look correct?

Thanks Very much!


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## marvelh (Jan 9, 2012)

Typically, a percutaneous placement of Greater occipital nerve neurostimulator lead would not equate to an epidural spinal neurostimulator placement, instead look at 64555 for Peripheral nerve.

Some providers may consider the supraorbital to be a cranial nerve rather than peripheral nerve as it is a distal branch of the Facial nerve which is a branch of the V1 division (Ophthalmic nerve) of the Trigeminal nerve. You would look at 64553 for percutaneous implantation for cranial nerve.  Some other providers consider this also to be a peripheral nerve due to it's "branch of branch of branch" anatomy, which would be reported with the 64555.


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