1. 99214 can be billed in conjunction with a procedure if it meets the criteria for use of 25 modifier. See NCCI Policy manual for use of 25 modifier and examples of when modfier 25 would apply.
: Modifier 25 could be realistic on encounter with programming if the programming was personally performed by the physician (the only time it would be appopriate to report eh program or rare occasion of incident to where his staff was trained to program a SCS device) and additional therapies such management of prescriptions, additional conditions, or extended history and examination of the underlying problem is necessary. If the programming is provided by the manufacturer's rep, 95971 would not be billable. With current stimulators, they are considered complex stimulators and would need to verfiy if 95972 would better describe the programming and capabliites of the SCS device.
2. See Dec 2010 CPT Assistant, 77003 is NOT separately reportable with 63650. It is also mentioned in CPT Assistant that programming is not reportable during a trial. 9597x codes for "implanted" pulse generators as seen in their descriptors and mentioned in CPT Assistant. In order to bill 99214-25 it would have to meet the criteria of "separately, identifable " E/M encounter that went "above and beyond" the pre and post work associated with doing the procedure. . On the scheduled day of the procedure, the patient would have the procedure not typically meet with the physician and have a detailed history/exam and moderate level decision making separate from focusing on performing the procedure for the patient.
I would review CPT Assistant and NCCI policy manaul
CPT Assitant December 2010
Question:A physician uses fluoroscopic guidance while inserting a percutaneous epidural neurostimulator lead (code 63650). Is the fluoroscopic guidance separately reportable or is it considered inclusive of the percutaneous implantation?Marvel J Hammer RN CPC CCS-P PCS ACS-PM CHCO, Denver, CO
Answer:Fluoroscopic guidance (codes 76000 and 77003) is considered inherent in the performance of the percutaneous implantation of the neurostimulator electrode array in the epidural space as represented by code 63650, Percutaneous implantation of neurostimulator electrode array, epidural. Therefore, it is not appropriate to additionally report the fluoroscopic guidance.
Note in the below December 2010 CPT Assistant it states other than external pulse generators---thus 95971-95972 can not be reported during a trial
Question:The physician performs a laminectomy for implanting spinal cord stimulator electrodes for a â€śsimpleâ€ť peripheral neurostimulator system. The patient is awakened intraoperatively to perform testing and programming of the device to ascertain whether placement of the electrodes covers the patientâ€™s pain/paresthesia. The patient is then placed under anesthesia for placement of the generator, and electrode connections are made. May the electronic analysis (code 95971) be reported in addition to the neurostimulator insertion codes 63655 and 63685? What documentation about the analysis should be in the operative note?
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).
Chapter 8 of the NCCI Policy Manual
If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an
E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is â€śnewâ€ť to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits. Neither the NCCI nor Carriers (A/B MACs processing practitioner service claims) have all possible edits based on these principles.
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