Pain Management Coding Alert

Question: The provider saw a patient for an outpatient evaluation and management (E/M) service. During the physical examination, the provider documented that she interrogated the vagal nerve stimulator and did not get a low battery indication. Is this enough to code a 95970 in addition to the E/M visit?

Indiana Subscriber

Answer: In order to code 95970 (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 brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming), the provider must perform an electronic analysis of a previously implanted peripheral neurostimulator pulse generator system.

The provider must test for each of the following features in order to report this code:

• alternating electrode polarities,
• pulse amplitude,
• pulse duration,
• pulse frequency,
• eight or more electrode contacts,
• train spacing,
• cycling,
• number of programs,
• number of channels, and
• dose time.

Additionally, the provider must examine more than one of the patient’s clinical features, such as a tremor.

This code does not involve any sort of reprogramming by the provider.

While the new patient E/M codes 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making …) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity …) and 95970 are mutually compatible from a National Correct Coding Initiative (NCCI) perspective, the physician’s documentation of the electronic analysis does not justify use of code 95970.

Best bet:  It is recommended that you inquire with the provider to make sure that the analysis was not more

extensive than what he documented in the physical examination portion of the E/M visit. 

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