Complete, Current Pain Management

Part 2: Make room for the latest in CPT® coding.

By Marvel J. Hammer, RN, CPC, CCS-P, CHCO, ACS-PM, and G.J. Verhovshek, MA, CPC

CPT® 2012 has brought important changes to pain management coding. Last month, in the article “Move Over Obsolete Pain Management Coding,” we reviewed new coding guidance for sacroiliac (SI) joint injection, “open” versus “percutaneous” disc procedures, single epidural injections, and facet joint nerve destruction. In the second and final portion of this article, we will discuss revised combination codes for pump refill and programming, coding methodology changes for “simple” versus “complex” neurostimulator programming, and more.

Certified Professional Compliance Officer - CPCO

“New and Improved” Implanted Pump Refill and Reprogramming

According to Medicare review, implanted pump refill and analysis/reprogramming codes are reported together at least 75 percent of the time. As a result, 2012 brings new and revised codes for these services.

Pump Analysis Only: The descriptor for 62367 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill was revised to clarify the code should be reported only when the provider performs an analysis of the pump setting not in association with either reprogramming or refill.

Pump Analysis and Reprogramming Only: Code 62368 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming was not changed for 2012 and would be reported for analysis and reprogramming not associated with an implanted pump refill.

Pump Refill and Reprogramming: New code 62369 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill is reported for programmable implanted pump refill by a non-physician (previously billed using 62368 and 95990).

Pump Refill and Reprogramming by a Physician: Also new for 2012, 62370 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring physician’s skill) is used when a physician refills an implanted, programmable pump and also performs the reprogramming. These services previously were reported with 62368 and 95991 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring physician’s skill.

The implantable pump/reservoir refill codes, 95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed and 95991 have been updated to specify that electronic analysis, when performed, is an included component. These codes will primarily be used for the refilling and maintenance of an implantable non-programmable spinal or brain pump or reservoir.

New parenthetical instructions disallow reporting 62367-62370 with either 95990 or 95991.

Determination of Simple vs. Complex Neurostimulator Programming Changes

CPT® 2012 has revised the section guideline instructions for application of neurostimulator programming codes. Previously, the determination of simple versus complex programming was based on what the generator was capable of affecting. Starting in 2012, section guidelines indicate that neurostimulator analysis and program coding is based on the number of generator parameters that are changed during the programming session.

Neurostimulator Analysis Only: 95970 Electronic analysis of implanted neurostimulator pulse generator system (eg, 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 (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming

Simple Neurostimulator Programming: 95971 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming

Simple intraoperative or subsequent programming of the neurostimulator pulse generator/transmitter (95971) includes changes to three or fewer of the following parameters: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time, and more than one clinical feature (e.g., rigidity, dyskinesia, tremor).

Coding for complex neurostimulator programming is determined by location (spinal, cranial, etc.) and total time spent changing at least four of the above-listed parameters:

Spinal Cord or Peripheral Complex Neurostimulator Programming: 95972 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour and +95973 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (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)

Cranial Nerve Complex Neurostimulator Programming: 95974 Electronic analysis of implanted neurostimulator pulse generator system (eg, 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 and +95975 Electronic analysis of implanted neurostimulator pulse generator system (eg, 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, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)

Also new for 2012 is a parenthetical note directing providers to append modifier 52 Reduced services to 95972, 95974, and 95978 if the programming time is fewer than 31 minutes.

Apply Coding Changes and Guidelines

For example, at a postoperative follow-up visit the physician spends 10 minutes making program changes to the pulse amplitude and pulse frequency for a greater occipital nerve neurostimulator generator inserted six days ago for occipital neuralgia. Proper physician office coding is 95971 (based on only the number of generator parameters changed, not time) with diagnoses of 723.8 Other syndromes affecting cervical region and V53.02 Fitting and adjustment of neuropacemaker (brain) (peripheral nerve) (spinal cord). Analysis and programming are not considered part of the surgical global package and are separately reportable during the global period.

In a second example, two days post-permanent implantation of two lumbar epidural neurostimulator arrays and a pulse generator, the patient presents to the office for initial programming of the pulse generator. The spinal cord neurostimulator was inserted for complex regional pain syndrome (CRPS) type II of the bilateral lower extremities. The physician spends 45 minutes setting the initial generator parameters for the 16 electrode contacts including rate, pulse amplitude, duration, and frequency. Proper coding would be 95972 with 355.71 Causalgia of lower limb and V53.02.

As a final example, a patient presents to the office with complaints of increased pain, questioning if the epidural neurostimulator is working. The spinal cord neurostimulator was initially placed for lumbar post-laminectomy syndrome. The physician performs an analysis of the pulse generator and spends a total of 25 minutes making changes to the following parameters for the eight electrode contacts: stimulation train duration, train spacing, and dose time. In this case, proper coding is 95972-52 (because fewer than 31 minutes are spent reprogramming), 722.83 Postlaminectomy syndrome; lumbar region and V53.02.

 

Marvel J. Hammer, RN, CPC, CCS-P, CHCO, ACS-PM, is owner of MJH Consulting in Denver, Colo.

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