Neurology & Pain Management Coding Alert

Treatment for Parkinson's disease may include implantation of deep brain stimulators, which must be programmed and adjusted. This time-intensive service alleviates the disease's debilitating symptoms and improves the quality of life for sufferers, but can result in disproportionately low reimbursement. But, physicians can guarantee the highest-available compensation by communicating with payers and providing thorough documentation of all stimulus parameters adjusted.
All About DBS
Patient's undergoing treatment for Parkinson's disease often receive drugs such as Levodopa (L-dopa), Pramipexole (also known as Mirapex) or Ropinirole (a.k.a. Requip) to control tremors and other symptoms. If drugs are ineffective, the patient may be treated surgically, which can include cranial placement of deep brain stimulators (DBS), 61850-61886. DBS use electrical stimulation of specific deep brain structures via tiny implanted electrodes and may be programmed for optimal results, says Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.
 
As explained by the local medical review policy (LMRP), # 99.07, for Blue Cross/Blue Shield of North Dakota (BCBSND), the Part B carrier for Colorado, North Dakota, South Dakota and Wyoming, "Since patients require some time to build up tolerance for optimal stimulation, the pulse generator needs to be programmed/analyzed or adjusted at a more frequent level in the first 18 months of use. Typically, the generator is programmed intraoperatively, 'ramped up' two weeks later, and adjusted thereafter until optimal efficacy is achieved." A surgeon places the DBS unit, while a neurologist often provides subsequent adjustments.
 
Note: According to LMRP #00-7 of the National Heritage Insurance Company (NHIC), the Part B provider for Texas, coverage for DBS "is for IPD (idiopathic Parkinson's disease) that has unequivocally responded to pharmacological treatment and became refractory or for which pharmacological response has been poor." Other carriers specify similar guidelines.
Simple or Complex?
CPT and Part B Medicare carrier LMRPs list four codes to report analysis and/or reprogramming of the DBS unit. Note that 63690 and 63691, previously used to report these services, were deleted as of Jan. 1, 1999.
 
  95970 electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (i.e., cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming
 
95971 simple brain, spinal cord, or peripheral (i.e., peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming
 
95972 complex brain, spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour
 
95973 each additional 30 minutes after first hour (list separately [...]