Eli's Rehab Report

Minor alterations to 63685 and 64590 are still important

CPT Codes 2005 makes minor changes for intradiskal electrothermal annuloplasty (IDEA) and neurostimulator pulse generator codes that may still have an impact on PM&R practices.

1. IDEA: Medicare released 0062T (Percutaneous intradiskal annuloplasty, any method, unilateral or bilateral including fluoroscopic guidance; single level) or +0063T (... one or more additional levels [list separately in addition to 0062T for primary procedure]) July 1, but as of Jan. 1, you'll be able to find them listed in the CPT book.

Just because these codes reach the book on Jan. 1 doesn't mean you shouldn't be using them now. "Because  Category III codes are new-technology codes, the AMA felt that release of the codes twice a year was required so that data could be accumulated as soon as possible to ensure these temporary codes could be converted to Category I CPT codes in a timely fashion," says Melanie Witt, RN, CPC, MA, an independent coding consultant in Fredericksburg, Va.

Therefore, make sure you list these codes in your coding resources as a handy reference. When your physician performs IDEA, you should already be using 0062T or 0063T - not the unlisted-procedure code 64999 (Unlisted procedure, nervous system).

2. Grammatical change to 63685/64590: When you look for a code to reflect your physician's placement of a neurostimulator pulse generator or receiver, you'll note a change in the definition. CPT has deleted "incision and subcutaneous placement" and changed the wording to "insertion or replacement":

63685 - Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling

64590 - Insertion or replacement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling.

3. Deletion of "brain" from code descriptor: CPT deleted the term "brain" in the code descriptions for three codes:

95971 - Electronic analysis of implanted neurostimulator pulse generator system ...; simple spinal cord, or peripheral (i.e., peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming

95972 - ... complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour

+95973 - ... complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (list separately in addition to code for primary procedure).

Remember: Make sure your physician's documentation indicates the number of parameters controlled, so you can apply the correct code.

A simple neurostimulator (95971) controls three or fewer of the following stimulus parameters, according to CPT: 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 or more than one clinical feature.

A complex stimulator (95972 and 95973) affects more than three of the above. The physician may need as many as six hours over several sessions to program the stimulator.