Neurology & Pain Management Coding Alert

Question: What role does time play when I choose between "simple "and "complex" codes for neuro-stimulator adjustments? For example, what if the neurologist states she spent one hour adjusting the stimulator? Massachusetts Subscriber Answer: Time is not a factor when determining whether neurostimulator programming qualifies as "simple" or "complex." Rather, you should consider the parameters the neurologists adjusts. CPT includes three primary codes to describe neurostimulator programming:

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 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 in addition to code for primary procedure). A simple neurostimulator (95970 and 95971) controls three or fewer of the following stimulus parameters, according to CPT: 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 or more than one clinical feature.

A complex stimulator (95972 and 95973) affects more than three of the above. The physician may need as many as six hours, over several sessions, to program the stimulator. If the neurologist adjusts a simple neurostimulator, you may report only 95971, regardless of the time involved. If she adjusts a complex neurostimulator, however, you may consider time a factor. Report 95972 for the first hour and 95973 for each additional 30 minutes. -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.