Neurosurgery Coding Alert

Question: Our physician performed a complex spinal cord neurostimulator test and subsequent programming which lasted 53 minutes. To report this service, will it be appropriate to append modifier 52 with code 95972?

Tennessee Subscriber

Answer: You will not need modifier 52 (Reduced services) with code 95972 (Electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; complex spinal cord, or peripheral [i.e., peripheral nerve, sacral nerve, neuromuscular] [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming) for reporting this service. The code includes the services for subsequent programing of the neurostimulator. As with many services, there is a range of times applicable for the provision of the service and elimination of the specific time component recognizes the range that exists.

No time component: CPT^® revised the 95972 descriptor in 2016 and dropped the terminology of “up to 1 hour.”

Check with payers: You can check with individual payer’s policy on 95972 before you file a claim. You should prove medical necessity and ensure the physician’s services meet the required parameters of the test.