Neurology & Pain Management Coding Alert

To avoid denials, make sure you're up to date on these crucial 2012 programming changes.

You should report codes depending upon the number of changes that were made in the pulse generator. You do not look at what the generator is capable of affecting. Changes may be done for pulse amplitude, pulse duration, train spacing, number of programs, number of channels, alternating electrode polarities, output modulation, cycling, impedance and patient compliance measurements.

"If the generator is only analyzed with no programming, then code 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, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming) is reported," says says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co.

Carefully read to pick up what changes were made in the neurostimulator pulse generator system. "IF there are changes made to the one to three of the various parameters, then it is considered to be simple programming and 95971 (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 spinal cord, or peripheral [i.e., peripheral nerve, sacral nerve, neuromuscular] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming) would be billed," says Hammer.

Confirm if the programming was complex and turn to timing the physician work. "If changes are made to four or more parameters, this would be considered to be complex programming and the coding would be based on the amount of physician time spent in programming, i.e. 95972 (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]; complex spinal cord, or peripheral [i.e., peripheral nerve, sacral nerve, neuromuscular] [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour) and potentially +95973 (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]; complex spinal cord, or peripheral [i.e., peripheral nerve, sacral nerve, neuromuscular] [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour [List separately in addition to code for primary procedure])," says Hammer.

Example: You would report code 95972 when the surgeon makes changes in at least four of the listed parameters and the documentation indicates the pain management provider spent at least 31 minutes in programming. If the provider spent less than 31 minutes in the complex programming, you need to append modifier 52 (Reduced services) to the 95972 code. In an extended programming session, you report code +95973 for every additional 30 minutes the provider spends in the complex programming.

If the pain management provider makes changes to only one to three of the neurostimulator generator parameters, it is considered to be simple programming and you would report code 95971. If, however, no generator parameters were changed and it was only analyzed, you would report 95970.

Remember: If you read that the physician removed the pulse generator for a failed battery and replaces it with a new generator, you select code 63685. "Append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) only if the replacement or revision occurs in the global period of the initial procedure," says Dr. Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.