Neurology & Pain Management Coding Alert

As of CCI 7.1, HCFA has not eliminated the edit bundling 95974 (... complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour) into 61885 (incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array).

In the introductory language to neurostimulator codes 61850-61888, this CCI pairing is in direct contravention to CPT 2001, which states, for initial or subsequent electronic analysis and programming of neurostimulator pulse generators, see codes 95970-95975. This edit means that neurosurgeons who would implant the complex cranial neurostimulator and then program it can no longer get reimbursed for this when it is done at the same time as its placement, which may result in neurosurgeons referring these patients to neurologists who can get paid for programming.

You should also be aware that 95970, 95971, 95972, and 95974 were incorrectly bundled into the E/M codes with CCI edit version 6.3. These incorrect edits have been suspended, but HCFA is reviewing them and some may be
reimplemented no earlier than July 1, 2001.

Coders should review denials received for neurostimulator programming codes and resubmit applicable claims. Any denied E/M services meeting the criteria of significant and separately identifiable should be resubmitted with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).