Neurosurgery Coding Alert

Question: Our surgeon implanted a Vagal Nerve Stimulator and documented electronic analysis she did in the OR stating ‘communication okay, output current okay, Current delivered 1 mA, Lead impedance within normal limits at 1860.’ No time was documented. Can we bill the testing using code 95974 (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 cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour)?

Florida Subscriber

Answer: You can bill code 95974 apart from the insertion codes 61885 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) and 64568 (Incision for implantation of cranial nerve [e.g., vagus nerve] neurostimulator electrode array and pulse generator). According to CPT^®, you report codes 95970 (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]; simple or complex brain, spinal cord, or peripheral [i.e., cranial nerve, peripheral nerve, sacral nerve, neuromuscular] neurostimulator pulse generator/transmitter, without reprogramming)—95975 (…with intraoperative or subsequent programming, each additional 30 minutes after first hour [List separately in addition to code for primary procedure]) for the initial or subsequent electronic analysis and programming of neurostimulator pulse generators.

Codes 95974 and +95975 are time-based codes. You need documentation for timing to be able to report this code. It is clear from your question that your surgeon implanted a stimulator and then did the programming.

If your surgeon does not mention the time for programming, you may still get paid separately for programming code but the payment will be based on the lowest level code, i.e., 95974 only. Even if you have spent time more than 1 hour, lack of documented time will cause you to lose payment for +95975.