Wiki clarification on 95972

[rdewitt]

When a rep from a spinal cord stim (SCS) company is in the physician's office and he/she performs the reprogramming, not the physician or any other staff employed by the physician, would you still report code 95972? The SCS company is telling us to report at our own discretion because it has not been defined by CMS as to the use.
Thanks,
Ruth

 

[RebeccaWoodward*]

No! They are providing MISGUIDED advice. CMS has clearly defined who can bill for services...legally.

30 - Physician Services
(Rev. 1, 10-01-03)
B3-2020, B3-4142
A. General
Physician services are the professional services performed by a physician or physicians for a patient including diagnosis, therapy, surgery, consultation, and care plan oversight. The physician must render the service for the service to be covered..

"Incident to" doesn't apply either since the rep is not an employee.

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

 

[nabernhardt]

ok I have a similar situation in which our physician did a placement of a neurostimulator and then also the intraoperative progamming was performed. In the op note the physician states that the rep from Medtronic did the progamming. The physician documented this:

The neurostimulator was then tested using the programmer with a sterile sheath placed over the antenna and the rep from Medtronic did the programming and activated the neurostimulator. The electrode settings were 2-negative, 0-positive with a pulse width of 210 and a rate of 14. The patient was eventually set up with a cycling program, 16 seconds on, 8 seconds off with a 4 second soft start. The impedance was checked, tested at an amplitude of 1.5 and a pulse width of 300, therapy impedance 1,216 and all
connections were within proper impedance ranges. The InterStim 2 neurostimulator serial number was NJY179071H.


I am just wanting clarification that we could still not charge for the progamming. Is that correct?