Pain Management Coding Alert

Reader Question:

Check All Boxes Before Filing 95970 With E/M

Published on Thu Nov 07, 2019

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Question: The provider saw a patient for an outpatient evaluation and management (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?

Indiana 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 new patient E/M codes 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making …) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity …) 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.