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VNS coding for 2019


South Bend, Indiana
Best answers
Hoping for some help here. I work for an surgeon who places vagal nerve stimulators to treat epilepsy. He programs them while in the operating room. The code for placing a new VNS is 64568, and per CPT instructions, the programming is not considered to be inherent in the placement, thus billable separately. The codes for 2019 for the programming are 95976/95977. When I look in CCI, those bundle to the placement code. ???

To add another quirk, if he changes out the VNS generator(CPT 61885), and he programs it, those do NOT bundle.

I cannot for the life of me understand why CPT and CCI seem to directly conflict for placement/programming. I also don't understand why programming is billable with replacement if it's not billable with placement. You would have to program the machine in either case.

A modifier is allowed to break the bundle, but I'm not clear on when it would/wouldn't be appropriate to do so.

Can someone help, please?


Local Chapter Officer
Best answers
I am new to EMG coding. I am struggling with Nerve conduction studies counting. My problem is with F-waves - I have physicians coming back stating they should be counted as a separate study. Please HELP!
How would you count the following:

The F-Wave is counted as part of the Nerve Conduction Studies and is not to be counted separately. On page 200, column 2 in the 2019 CPT Manual it notes "That for the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with or without an F-wave test, or an[sic] H-reflex test." My neurologists do not count the F-wave as a separate test because it is included in the NCS codes 95907-95913. If there is a neuromuscular junction test conducted (repetitive stimulation) that is a separate code that can be billed (95937).