"Programming codes 95971 and 95972 also may not be assigned to represent test stimulation during the implantation procedure, and NCCI edits do not permit programming codes 95971 and 95972 to be coded separately with lead or generator implantation. However, an override is permitted in the context of actual programming performed at the time of lead or generator implantation."
Above is from the Medtronics reimbursement guide for Spinal Cord Stimulation
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1. Don't Boston Scientific reps typically used a device that they bring with them to do the programming and technically the rep is performing the programming. Does the physician have training to utilize their equipment and is there anything to support he personally using their equipment to perform the programming, if not and the rep actually doing this under his supervision, he can not bill as personally performing under the incident to benefit as it only applies to someone that is his employee working under his direction is my understanding. Additionally, from the AMA performed does not mean standing there why the rep provides a service that free of charge to insurance when the rep perfoms. I don't know the circumstance and he might choose to do his own programming, but I think it is the most important take away when discussing this service. This is also mentioned in AMA CPT Assistant Feb 2019:
"Editorial revisions were also made to existing codes 95971 and 95972 to clarify that these codes should be used to report the electronic analysis and programming of spinal cord or peripheral nerve (eg, sacral nerve) neurostimulators, and specifies that these services are performed by a physician or other qualified health care professional (QHP). "
2, The operative note provided does not support CPT 95972. CPT 95972 requires more than 3 parameters that might be in separate note but the note that is provided does not describe the physician documenting he personally programmed more than 3 parameters.
AMA CPT Assistant Feb 2019
For purposes of counting the number of parameters being programmed, a single parameter that is adjusted two or more times during a programming session counts as one parameter. Simple and complex programming are defined as follows: • Simple programming of a neurostimulator pulse generator/transmitter includes adjustment of one to three parameter(s). • Complex programming includes adjustment of more than three parameters.
3. From AMA CPT Assistant April 2011, temporary lead placement./trial can be billed with programming and they do not describe it as being inherent to the trial although I agree that there has been other entities saying they believe it is inherent, I believe at one time the AANS global surgery package guide stated it was included in the trial is what a Medtronic rep told me:
"Question 3: May code 95972 be reported for complex programming of an external nonimplanted neurostimulator pulse generator that is attached to a temporary electrode array?
AMA Response: Correct choice of programming codes is not based upon the intent of the stimulator lead array being used as a “temporary” external lead or as a “ permanent” implanted lead. An inherent portion of the lead placement, and is not additionally reported using either code 95971 or 95972, is electronic analysis during a percutaneous electrode array placement (63650) or during a laminectomy for implantation of a plate/paddle electrode array (63655) when only impedance testing and stimulation is performed to verify function of the leads (not the pulse generator). "