Neurology & Pain Management Coding Alert

To receive just compensation, neurologists reporting analysis and/or programming of implanted neurostimulators must document all of the stimulus parameters adjusted, as well as observe frequency limitations imposed on these services. Fortunately, a quick review of payer and CPT requirements can provide all the necessary guidance. Why Neurostimulate? A neurostimulator pulse generator system is a surgically implanted, pacemaker-like device that delivers preprogrammed intermittent electrical pulses to a particular nerve(s) or brain structure(s). Neurologists use this system to treat several conditions that do not respond satisfactorily to medication alone, including Parkinson's disease, epileptic seizure, urinary urge incontinence and others. A physician, usually a neurologist, typically tests the device and leads and sets the initial programming parameters, both in the operating room and in the office setting during the days and weeks following the implant, says Petrina White, CPC, coding specialist in the department of neurosurgery at Vanderbilt University Medical Center in Nashville, Tenn. For example, a typical Medicare local medical review policy (LMRP) explains, "[Because] patients require some time to build up tolerance for optimal stimulation, the pulse generator needs to be programmed/analyzed or adjusted at a more frequent level in the first 18 months of use. Typically, the generator is programmed intraoperatively, 'ramped up'two weeks later, and adjusted thereafter until optimal efficacy is achieved." Observe Frequency Limitations The appropriate analysis/reprogramming code depends on the type and location of the pulse generator, which in turn depends on the patient's condition. For example, report neurostimulator reprogramming/analysis for vagal nerve stimulation (to treat refractory epileptic seizure) or sacral nerve stimulation (for urinary urge incontinence) as 95970, 95974 or 95975. Code the same service for deep brain stimulation (DBS) to treat Parkinson's disease as 95970, 95971-95973, depending on circumstances (see Neurostimulator Analysis/Programming Codes on page 19 for descriptors). Applicable ICD-9 codes and coverage limitations vary by payer and condition, but you will generally report the same diagnosis that provided justification for the pulse generator's implantation, says Frank Falco, MD, an AMACPTeditorial board member representing the American Academy of Physical Medicine and Rehabilitation. For instance, if the neurosurgeon cites a diagnosis of 345.51 (Partial epilepsy, without mention of impairment of consciousness, with intractable epilepsy, so stated) when reporting implantation (61850-61886), you may link 345.51 to 95974 to show medical necessity for programming. According to the typical local Medicare carrier policy, if you can demonstrate medical necessity, programming codes (95971-95975) "will be reimbursed at a frequency of every 30 days." However, Blue Cross Blue Shield North Dakota (BCBSND) #99.07 further specifies, "Billing any of the 9597x procedure code series after the first analysis/programming session will require submission of supporting documentation for the necessity of the service." This would include evidence of worsening symptoms (for example, rigidity) or [...]