Neurology & Pain Management Coding Alert

Question: Should I consider time when choosing a neurostimulator programming code?


New York Subscriber

Answer: In every case, you should consider time a factor when the neurologist provides complex cranial neurostimulator programming.

Use 95974 (Electronic analysis of implanted neuro-stimulator 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 cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour) to report the first hour of programming and intraoperative (at initial insertion/revision) or subsequent electronic analysis of an implanted complex cranial nerve neurostimulator.

For each additional 30 minutes of service beyond the first hour, you should report one unit of +95975 (... each additional 30 minutes after first hour [list separately in addition to code for primary procedure]).

For brain, spinal cord, and other peripheral neuro-stimulation, you should only use time as a factor if the device is complex. A complex neurostimulator affects four or more of the following parameters: 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.

Report 95972 (Electronic analysis of implanted neuro-stimulator 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 [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour) for the first hour of programming. Report +95973 (... each additional 30 minutes after first hour [list separately in addition to code for primary procedure]) for each additional half hour of service thereafter.

For all of the above codes, you may report an additional 30 minutes if the time extends at least 16 minutes beyond the previously billed unit of time. For example, 72 minutes of programming equals 95972; 76 minutes equals 95972, 95973; 107 minutes equals 95972, 95973 x 2, etc.

As time spent performing the service, you may count face-to-face time with the patient, as well as time spent on the floor or unit after adjusting the programming, waiting for the patient to respond and to monitor for side effects.