Neurology & Pain Management Coding Alert

Question: The provider saw a new patient for an outpatient evaluation and management (E/M) consult (99204). During the physical examination, the provider documented that she interrogated the vagal nerve stimulator and did not get a low battery indication. Is this enough to code a 95970 in addition to the E/M visit?

Idaho Subscriber

Answer: In order to bill out for a 95970 (Electronic analysis of implanted neurostimulator pulse generator system [eg, rate, pulse amplitude, pulse 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...), the provider must perform an electronic analysis of a previously implanted peripheral neurostimulator pulse generator system.

The provider must test for each of the following features in order to bill out for this code:

• alternating electrode polarities,
• pulse amplitude,
• pulse duration,
• pulse frequency,
• eight or more electrode contacts,
• train spacing,
• cycling,
• number of programs,
• number of channels, and
• dose time.

Additionally, the provider must examine more than one of the patient's clinical features, such as a tremor. This code does not involve any sort of reprogramming by the provider.

While 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity ...) and 95970 are mutually compatible from a Correct Coding Initiative (CCI) perspective, the physician's documentation of the electronic analysis does not justify use of code 95970. It is recommended that you inquire with the provider to make sure that the analysis was not more extensive than what he documented in the physical examination portion of the E/M visit.