Neurosurgery Coding Alert

If you forget to charge for programming of a deep brain stimulation (DBS) unit, you may be forfeiting an important reimbursement opportunity.
 
Following implantation of a DBS unit, the surgeon (or a neurologist) must test the device and leads and set the initial programming parameters, both in the operating room and in the office setting during the days and weeks following the implant. CPT provides several codes for this service, including:
 
95970 Electronic analysis of implanted neuro-stimulator pulse generator system (e.g., rate, pulse amplitude and 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 (i.e., cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming

  95971 simple brain, spinal cord, or peripheral  (i.e., peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming
 
95972 complex brain, spinal cord, or peripheral  (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent
programming, first hour
 
+95973 complex brain, spinal cord, or peripheral  (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). Not All Payers Allow Separate Reimbursement CPT states that the codes for surgical implantation of a pulse generator do not include evaluation, testing, programming or reprogramming. WPS Medicare Part B for Illinois and Michigan (policy NEURO-004), for example, states, "General practice is for the neurosurgeon alone to bill for the surgery A separate procedure code for electronic analysis services (CPT 95974 or 95975) may be appropriate if the neurologist/neurophysiology team adjusts and initiates initial stimulus levels in the operating room." Not all payers follow CPT guidelines, however. Blue Cross/Blue Shield North Dakota's local medical review policy (LMRP) states, "Adjustments during the initial 90 days after implantation are considered to be part of the global period."
 
And the National Correct Coding Initiative (NCCI) and many Medicare LMRPs bundle simple analysis/programming (95971) to pulse generator placement but will allow you to bill separately for complex pulse generator programming (95972-95973). Because of the variability of coverage limitations and bundling issues, contact your individual carrier for its guidelines prior to billing.
 
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." Blue Cross Blue Shield North Dakota (BCBSND) #99.07 further specifies, however, that "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 demonstrated adverse effects arising from the current neurostimulator settings.
 
Applicable ICD-9 codes and [...]