Parkinsons Disease:
Optimize Reimbursement for Programming Deep Brain Stimulators
Published on Mon May 01, 2000
Parkinsons (332.0) sufferers often exhibit symptoms including uncontrollable severe writhing and violent movements that can propel them out of chairs. These symptoms ultimately can leave patients unable to care for themselves. Treatment of Parkinsons disease with drugs such as Ropinirole (also known as Requip) or Pramipexole (or Mirapex) often is not effective in helping to regulate the diseases debilitating symptoms and affording patients a better quality of life. Recent studies have indicated that early and prolonged use of Levodopa (L-dopa) actually may cause the premature onset of some of the more extreme symptoms.
Bill for Stimulator Programming
Implanting deep brain stimulators to control these symptoms occasionally is necessary. Neurologists often work hand-in-hand with neurosurgeons performing surgical interventions for Parkinsons disease, with the neurologists handling the programming of the deep brain stimulators.
But a controversy exists concerning reimbursement for programming or adjusting these stimulators, a process that is done in the wake of the implantation surgery and may take as much as six hours in selected cases and involve multiple sessions with the patient.
Richard Roski, MD, American Medical Association (AMA) CPT advisor for the American Association of Neurological Surgeons and a neurosurgeon who treats Parkinsons patients at Quad City Neurosurgical Associates, a center with five neurosurgeons in Davenport, Iowa, says that from the perspective of many insurance carriers, reimbursement for programming these stimulators has nothing to do with the amount of time a neurologist may have to invest.
The argument is that with a simple generator, the neurologist may only adjust a limited number of variables and so there is an assumption that limited time will be spent, and a low flat rate is applied, Roski says. If multiple variables are involved, such as four or more, then the process is designated complex and may be billed in time increments provided reprogramming is involved.
Drawing the Line Between Simple and Complex
CPT 2000 says a simple neurostimulator (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, phase angle, alternating electrode polarities, configuration of wave form, more than one clinical feature (e.g., rigidity, dyskinesia, tremor). A complex neurostimulator (95972, 95973, 95974, 95975) is one capable of affecting more than three of the above.
Erwin Montgomery, MD, director of the movement disorders program from the Cleveland Clinic in Cleveland, which has more than 40 neurologists on staff, says that Medicare, the AMA and many insurance companies have taken the position that adjusting deep brain stimulators is a simple process and very little distinction is being made between the treatment of essential tremor and Parkinsons disease. He [...]
