Neurosurgery Coding Alert

Hint: Never report 95976 in conjunction with 95977.

If you thought implanted neurostimulator claims were always challenging, then you may find some relief after Jan. 1. CPT^® 2019 will add four new electronic analysis of implanted neurostimulator codes for you to choose from. But beware: to go along with these codes, you will also need to dig into several new pages of CPT^® guidelines.

Read on to make sure you know how to report these new codes correctly when the codes become effective on Jan. 1, 2019.

Mark Down These New Analysis Codes

When January 1 comes around, you will be able to turn to the following new electronic analysis and programming of implanted cranial nerve and brain neurostimulator codes. These new codes will join existing codes 95970 through 95972 and should be reported for cranial nerve and brain neurostimulators. They are as follows:

• 95976 (Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional).
• 95977 (… with complex cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional)
• 95983 (… with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to)-face time with physician or other qualified health care professional)
• +95984 (… with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)).

Break it down: You should report either code 95971, 95972, 95976, 95977, or 95983, depending on the anatomical target when a physician or other qualified health care professional programs a neurostimulator, per CPT^®. Only the programming of the brain neurostimulator (95983) is time-based, with additional 15-minute increments reported with add-on code +95984, says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Don’t miss: Physicians can perform neurostimulator programming in various settings including operating rooms, postoperative care units, inpatient, and/or outpatient settings, via CPT^®.

“Programming a neurostimulator in the operating room is not inherent in the service represented by the implantation code and may be reported by either the implanting surgeon or other qualified health care professional, when performed,” CPT^® clarifies.

Dig deeper: “The electronic analysis and programming codes were revised when the typical times required to perform the services did not meet the CPT^® threshold for reporting,” explains Przybylski. “Now, analysis and programming codes will be reported based on the anatomical target and the complexity of programming (except for implanted brain stimulator programming).”

Analysis and programming of a brain stimulator will be time-based.

You should report analysis without programming with code 95970 for spinal cord, peripheral nerve, cranial nerve and brain neurostimulators (except during initial implantation, which is included in the implantation procedure), Przybylski says.

You should then report code 95971 for simple programming of spinal cord or peripheral nerve neurostimulators, Przybylski adds. On the other hand, you should report code 95972 for complex programming of spinal cord or peripheral neurostimulators.

Don’t Mix Up Neurostimulator Programming With Test Stimulation

Surgeons normally perform test stimulations when they implant a neurostimulator. These stimulations “confirm correct target site placement of the electrode array(s) and/or to confirm the functional status of the system,” CPT^® instruction explains.

CPT^® does not consider this test stimulation the same as the electronic analysis or programming a neurostimulator system. Instead, test stimulation is included in the implantation service code. Therefore, you should not report a test stimulation code with codes 95970-95972 and codes 95980-+95984.

Understand Programming Parameters

When it comes to the analysis and programming of neurostimulators, it’s also important to know what CPT® means when it mentions “parameters.” When a neurosurgeon performs the electronic analysis of an implanted neurostimulator pulse generation/transmitter, this service includes documenting the settings and electrode impedances of the system’s parameters before programming the device. Additionally, the programming includes fine-tuning the system’s parameters to take care of the patient’s symptoms and clinical signs.

Examples of these parameters include the following, according to CPT^®:

• Contact group(s)
• Interleaving
• Amplitude
• Pulse width
• Frequency (Hz)
• On/off cycling
• Burst
• Magnet mode
• Dose lockout
• Patient-selectable parameters
• Responsive neurostimulation
• Detection algorithms
• Closed-loop parameters
• Passive parameters.

Caution: Note that not all of the aforementioned parameters will be available for programming in every neurostimulator. Additionally, the available parameters may vary between systems, and the surgeon may have to adjust these parameters many times within a single programming session.

Count on These Instructions for 95971, 95972, 95976 and 95977

You should report either 95971, 95972, 95976, or 95977 when the surgeon performs cranial nerve, peripheral nerve, or sacral nerve, or spinal code stimulator analysis with the programming services. You should report these codes based upon the number of parameters the surgeon adjusted during a programming session, per CPT^®.

Simple programming: CPT^® defines simple programming of a neurostimulator pulse generator/transmitter as including the adjustment of one to three parameter(s). An example of a simple programming service would be 95976.

Complex programming: CPT^® defines complex programming as including the adjustment of more than three parameters. An example of a complex programming service would be 95977.

Don’t miss: “For purposes of counting the number of parameters being programmed, a single parameter that is adjusted two or more times during a programming session counts as one parameter,” per CPT^® instructions.

Caution: You should never report 95976 in conjunction with 95977, according to CPT^®. Similarly, you should not report 95971 in conjunction with 95972.

Learn These Rules for 95983 and +95984

CPT^® 2019 will delete codes 95978 (Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour) and +95979 (… each additional 30 minutes after first hour (List separately in addition to code for primary procedure)). Instead, you should report new codes 95983 and +95984 for these services, according to CPT^®.

If the surgeon performs the electronic analysis with programming of an implanted brain neurostimulator pulse generator/transmitter, then you would report new codes 95983 and +95984. For the first 15 minutes of physician or qualified health care professional face-to-face time for analysis and programming, you should report 95983. You would then report +95984 for each additional 15 minutes.

Don’t miss: CPT^® instructions specifically state that when reporting 95983 and +95984, if the physician or other qualified health care professional face-to-face time is less than eight minutes, you cannot report this service separately.

Putting it all together: The surgeon performs an electronic analysis of an implanted brain neurostimulator pulse generator/transmitter. He spends six minutes on this service. In this case, the analysis is not separately reportable because it lasted less than eight minutes.

However, consider if the surgeon instead performed the analysis for 11 minutes. In this case, the service would be considered reportable, and you would submit 95983 X 1 on your claim.