Neurology & Pain Management Coding Alert

Watch payer policies or watch your work get bundled into a surgical procedure Nerve stimulation is a powerful treatment tool when medication alone does not produce adequate relief for your patients. But if you are unsure of how to report your analysis and programming of neurostimulators, you may be feeling the pinch of inadequate reimbursement.

The basics: A neurostimulator pulse generator system is a surgically implanted, pacemaker-like device that delivers preprogrammed intermittent electrical pulses to a particular nerve(s) or brain structure(s). Neurologists use these systems to treat several conditions that do not respond satisfactorily to medication alone, including intractable pain in the trunk and/or limbs, arachnoiditis (322.9), peripheral neuropathy (356.0-356.9), Parkinson's disease (332.0), epileptic seizure (345.xx), urinary urge incontinence (788.31), and others.

The codes: See -Keep it in the Family: Your Shortcut to choosing accurate  Neurostimulator Codes- on page 35 for full descriptors of 95970-95979.

Follow these steps for worry-free coding of neurostimulator programming. Overcome 3 Thresholds for Complex Neurostimulators Before choosing the appropriate code from the 95970-95979 range, you-ll need to identify if you are dealing with a simple or complex neurostimulator.

If the system is used to stimulate the cranial nerve or involves deep brain stimulation, your choice is easy. In both of these cases, CPT will only allow you to use complex codes 95974-95979. But if you are faced with a spinal cord or peripheral neurostimulator, which are most commonly used, you-ll need to distinguish between simple and complex systems to select the appropriate code(s) from 95971-95973.

You need to decide by determining if you can clear the three-feature hurdle. According to CPT and American Academy of Neurology (AAN) guidelines, a simple neurostimulator is capable of affecting three or fewer of these features, while a complex neurostimulator is capable of affecting more than three:

- pulse amplitude
- pulse duration
- pulse frequency
- 8 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 the time periods of minutes including dose lockout time)
- more than one clinical feature (e.g., rigidity, dyskinesia, tremor). For example, a patient has a spinal neurostimulator for back-pain reduction. It affects pulse amplitude, pulse duration, and pulse frequency. In this case you would report 95971, because the neurostimulator is only capable of affecting three areas.

Important distinction: -The stimulation programming codes are based on what the system is capable of affecting and not on what parameters are being used for programming at any given programming session,- says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.

Rule of thumb: In almost all cases you encounter today, you can expect that stimulators will have complex capabilities, says Eric Moser, MD, of High [...]