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Vagal Nerve Stimulator Implantation with Programming

Maria Posted Tue 09th of April, 2013 19:32:07 PM

My surgeon implanted a Vagal Nerve Stimulator and documented electronic analysis she did in the OR stating "communication okay, output current okay, Current delivered 1 mA, Lead impedance within normal limits at 1860." Is the testing done in the OR billable to CPT 95974? No time was documented.

SuperCoder Answered Wed 10th of April, 2013 14:29:27 PM

95974 is billable apart from insertion code (61885 / 64568). As per CPT guidelines "For initial or subsequent electronic analysis and programming of neurostimulator pulse generators, see codes 95970-95975."

Maria Posted Wed 10th of April, 2013 15:45:02 PM

If time is not documented, would this be billable?

SuperCoder Answered Thu 18th of April, 2013 06:08:31 AM

95974-95975 are time-based codes, so time taken for programming should be well-documented. But the main piece of documenatation is a clear indication of stimulator implantation and separately reportable programming. If adequate documentation of programming is lacking, there would be diffulty of getting paid apart from implantation code.

However, in case time for programming is not mentioned, you can still get paid separately for programming code, based on availability of documentation, but the payment will be based on the lowest level code, i.e., 95974 only. Even if you have spent time more than 1 hour, a lack of time in the document will not get the payment for +95975.

The similar situation takes place usually in hospital discharge services, when the physician does not mention the time taken for discharge service from inpatient. Usually the service is paid @ code 99238, the base level code for discharge, and no payment for the add-on code +99239 is considered.

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