95970 vs 95971

barbara45

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My doc likes to use 95971 and a previous coder tried to explain that 95970 pays out more. What is the difference between these codes? Does the payout vary by state? (sorry if a silly question). The insurance company sent the denial back with a list of dx codes having to do with varying levels of paralysis, none of which the patient has. It was done for chronic back pain. Any ideas?

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dwaldman

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Below are some things I pulled from CPT Assistant, 95970 would be for analysis only for an implanted device, 95971 would be analysis with intraoperative or subsequent reprogramming of simple "spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter"

95972 is for a complex device---analysis with intraopertive or subsequent reprogramming of implanted neurostimulator pulse generator.
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Below is from CPT Assitant

"For analysis of an implanted neurostimulator pulse generator without reprogramming, code 95970 should be reported"

Simple vs Complex Neurostimulators

A simple neurostimulator pulse generator or transmitter is capable of affecting or changing three or fewer of the following features:

Pulse amplitude; pulse duration; pulse frequency; eight or more electrode contacts
Cycling (meaning automatic on and off for different times in terms of microseconds)
Stimulation train duration; train spacing
Number of programs; number of channels
Alternating electrode polarities
Dose time (stimulation parameters changing in time periods of minutes including dose lockout times)
More than one clinical feature (eg, rigidity, dyskinesia, tremor)

A complex neurostimulator pulse generator or transmitter, is one capable of affecting more than three of the these listed features.
 
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