Cpt 95971

millortsui

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I received a denial from Ins for the second unit. Doctor documentated that he inserted 2 electrodes implant (T9 and T10) on the patient and performed 2 different sites ( T9 and T10) of spinal cord analysis and testing. Could I charge 95971 for 1 unit or 2 unit? Please advice.
 

dwaldman

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If this was a trial (temporary lead attached to an external pulse generator) the programming would be inclusive and not separately reportable.

Below referencing a Q and A from Dec 10 CPT Assistant you can see that since the programming codes described an "implanted" pulse generator in their descriptor. This means that these codes can be reported only for permanent implanted device. In regards to billing once or twice. It would be once and you would want to confirm if this was for a simple spinal cord stimulator (95971) or complex (95972)
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Dec 10 CPT Assistant

Answer

Other than for external pulse generators, evaluation, testing, programming, or reprogramming of neurostimulator systems are not inclusive components of simple or complex pulse generator/transmitter insertion or removal with reinsertion (codes 61885, 63650-63655, and 63685). Reporting is based on what the system is capable of affecting and not on what parameters are being utilized for programming at any given programming session. Intraoperative initial or subsequent electronic analysis, and programming or reprogramming of an implanted simple brain, spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator system is represented by the stimulation programming code 95971, Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming.
 
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