# Programming code during Trial SCS Procedure



## Art111085 (Aug 29, 2012)

Can code 95972 be billed with code 63650 during the "trial" procedure?


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## dwaldman (Aug 30, 2012)

In order to report programming codes, the programming has be personally performed by the physician. If  the physician personally performed the programming, they would need  to indicate that it was personally performed by them in the procedure note for 95972. Additionally, 95972 is a time based code. For time base codes you have to indicate the time that was spent programming the  pulse generator. If under the half way point of 31 minutes is not met, you  will have to add the 52 modifier for reduced service and it will have to be manually priced. 95972 per the AMA has to have documented more than three of the following paramenters: rate, 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 contrast 95971 is considered simple programming and is not time based. Only 1-3 parameters have to be documented if personally performed by the physician. To support that it was not performed by the manufacturer's representative, it would require a statement that the physician personally performed it. 

Checking the functioning of the leads or impedence checks would not be reported with the progrogramming codes. 

 Below is from AMA CPT Changes 2012

Simple intraoperative or subsequent programming of the neurostimulator pulse generator/transmitter (95971) includes changes to three or fewer of the following parameters: rate, 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). Complex intraoperative or subsequent programming (95972 - 95979) includes changes to more than three of the above.



Changes have also been made to the neurostimulation 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 clarifications for guidelines to differentiate "simple" versus "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.

Below is part of a private response I received regarding this scenario from the CPT Network. 


"Based solely upon the information provided in your electronic inquiry, from a CPT coding perspective and according to our CPT Advisors and as indicated in the April 2011 edition of the CPT Assistant, the code for programming (95970, 95972-95973) is not dependent on the location of the generator (internally implanted or externally worn). Yes, the programming code may be reported if indeed programming is actually performed and the programming parameters documented (eg, pulse amplitude, duration). However, the code for programming is not reported when attaching the electrode to the generator and testing for the integrity of the system (commonly done initially after lead placement). This work does not constitute use of the programming code. To further clarify, the programming codes are not reported in the event a company representative is performing the device programming."


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## stonecm (Sep 10, 2012)

No, you cannot bill 95972 for trials. The code is for testing of an implantable pulse generator, the ipg is not implanted until the permanent leads are placed


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## dwaldman (Sep 11, 2012)

stonecm, 

Below is from the AMA which states the pulse generator does not have to be previously implanted. 

".....indicated in the April 2011 edition of the CPT Assistant, the code for programming (95970, 95972-95973) is not dependent on the location of the generator (internally implanted or externally worn)."

Below is from 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).


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