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Changes for Neurostimulator Coding

 by Emily Hill, PA, AAPM Coding Consultant

CPT 2019 made significant changes to the codes and guidelines for neurostimulator services. Code 64550 (Application of surface (transcutaneous) neurostimulator (e.g.TENS)) has been deleted. Parenthetical notes direct users to report 97014 for supervision of transcutaneous electrical nerve stimulation (TENS) or 97032 for constant attendance for TENS.

A number of guideline revisions have been made to define existing neurostimulator programming and analysis services. In addition, new codes were added for cranial nerve stimulation and brain neurostimulators and 4 cranial codes were deleted.

The new guidelines:

  • Provide definitions for analysis and programming
  • Identify different types of parameters
  • Defines simple and complex programming based on number of parameters
  • Includes special instructions on use of 95970

The guidelines define an electrode array as a catheter or other device with more than one contact which may be capable of being adjusted during programming services. Test stimulation to confirm correct target site placement of the array(s) and/or to confirm functional status of the system is inherent to the placement and is not separately reported as analysis or programming of system.

Electronic analysis involves documenting settings and electrode impedance of the system parameters prior to programming. Analysis is reported with code 95970 which is used for implanted brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve neurostimulator pulse generator/transmitter. For coding purposes, a neurostimulator system is considered implanted when the electrode array(s) is inserted into the target area for either permanent or trial placement. Some procedures inherently include analysis, therefore code 95970 should not be reported in addition to these procedures. The procedures that already include analysis are listed in the introductory language to the Neurostimulator, Analysis- Programming codes. The code specifies that the analysis must be done by the physician or qualified health care professional. Analysis by an industry representative or other personnel should not be reported.

Programming is reported using either code 95971 or 95972. Programming involves adjusting the system parameter(s) to address clinical signs and symptoms. The guidelines clarify that parameters may need to be adjusted multiple times during a single programming session.

Examples of parameters noted in the guidelines include contact group(s), interleaving, amplitude, pulse width, frequency (Hz), on/off cycling, burst, magnet mode, dose lockout, patient-selectable parameters, responsive neurostimulator, detection algorithms, closed loop parameters, and passive parameters. The difference in simple and complex programing is dependent on the number of parameters that are adjusted. Simple programming includes adjustment of 1-3 parameters while complex programming includes adjustment of > 3 parameters. Note that a single parameter adjusted multiple times counts as one parameter.

The new code descriptors for analysis and programming of spinal or peripheral nerves are:

  • 95970: Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming.

  • 95971: Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional.

  • 95972: Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional.

For a full understanding of the appropriate use of these codes and for the new codes for cranial and brain neurostimulator services, please see the guidelines and codes in CPT 2019.

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