Cut Through Complex Billing for Parkinsons Treatment Deep Brain Stimulators
Published on Wed Mar 01, 2000
Public awareness of Parkinsons disease has grown steadily in recent years. Parkinsons sufferer Michael J. Fox, who recently announced that he is leaving his popular television program Spin City to devote his time to fundraising and treatment of this disease, is only one prominent sufferer of this terrible illness. Mohammed Ali, Janet Reno, and the Pope John Paul II are all Parkinsons sufferers.
Neurosurgeons who perform surgical interventions for Parkinsons sufferers implant deep brain stimulators to help regulate the diseases debilitating symptoms and afford patients a better quality of life. But a controversy exists over reimbursement for programming or adjusting these stimulators, a process that often is done in the wake of the implantation surgery and may take as much as six hours in selected cases and involve multiple sessions with the patient.
Richard Roski, MD, American Medical Association (AMA) CPT advisor for the American Association of Neurological Surgeons, and a neurosurgeon who treats Parkinsons patients at Quad City Neurosurgical Associates, a center with five neurosurgeons in Davenport, Iowa, says that from the perspective of many insurance carriers, reimbursement for programming these stimulators has nothing to do with the amount of time a neurosurgeon may have to invest.
The argument is that with a simple generator, the neurosurgeon may only adjust a limited number of variables and so there is an assumption that limited time will be spent and a low flat rate is applied, Roski says. If multiple variables are involved, such as four or more, then the process is designated complex and may be billed in time increments provided reprogramming is involved.
Drawing the Line Between Simple and Complex
CPT 2000 says a simple neurostimulator (95970, 95971) is one capable of affecting three or fewer of the following: 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, more than one clinical feature (e.g., rigidity, dyskinesia, tremor). A complex neurostimulator (95970, 95974, 95975) is one capable of affecting more than three of the above.
Erwin Montgomery, MD, director of the movement disorders program from the Cleveland Clinic in Cleveland, Ohio, which has nearly 15 neurosurgeons on staff, says that Medicare, the AMA and many insurance companies have taken the position that adjusting deep brain stimulators is a simple process and very little distinction is being made between the treatment of essential tremor and Parkinsons disease. Montgomery reports that at present, the AMA has approved only the deep brain stimulation of the thalamus for tremors. He is hopeful that the federal Food and Drug Administration (FDA) will review the situation and give approval for deep [...]
