EM Coding Alert

Question: The provider saw a patient for an outpatient 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?

Illinois 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 E/M codes 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) 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.