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Complex spinal cord stim programming

  1. #1
    Default Complex spinal cord stim programming
    Medical Coding Books
    I have a question when billing cpt code 95972 (Electronic Analysis of implanted complex spinal cord neurostimulator pulse generator with programming) , first hour. If the programming only takes 10 minutes, do you need to add a modifer 52 for reduced service since the code reads first hour. Or does the code mean anywhere from 1-60 minutes of programming would be included in code 95972?? If there is documentation I could refer to that would be very helpful!!

  2. #2
    Intraoperative vs. Subsequent Analysis Reporting

    The stimulation programming codes 95970-95973 apply to: any return visit for implanted peripheral, brain, or spinal cord pulse generator/transmitters. Although not specifically stated in the descriptor nomenclature, codes 95972-95973 are intended to describe intraoperative initial or subsequent electronic analysis, programming or reprogramming of a neurostimulator pulse generator/transmitter.

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    With the articles I reviewed from CPT Assistant, I couldn't find where they specificially address the answer to your question. But it is my understanding that the first hour would mean that the physician provided the programing in 60 minutes or less.

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