Understand the New 2019 Neurostimulator Analysis-Programming CPT Coding Structure and Associated Relative Value Units

Transcription

1 Understand the New 2019 Neurostimulator Analysis-Programming CPT Coding Structure and Associated Relative Units The American Academy of Neurology (AAN) presents the following case studies to help you understand the appropriate use of each new or revised code for analysis and programming of neurostimulators as well as how the relative value units (RVUs) for the physician work ( work value ) have been affected. values are multiplied by the Medicare conversion factor and the local geographic price cost index to determine reimbursement. Vagus Nerve Stimulation (VNS) Programming 2018 CPT Descriptor Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour each additional 30 minutes after first hour NEW 2019 CPT Descriptor Electronic analysis of implanted generator/transmitter (eg, 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 cranial nerve generator / transmitter programming by physician or other qualified health care professional with complex cranial nerve generator / transmitter programming by physician or other qualified health care professional 2018 codes for VNS programming were reported based on time codes are reported based on the number of parameters reviewed Simple programming of a generator/transmitter includes adjustment of one to three parameter(s). Complex programming includes adjustment of more than three parameters.

2 VNS Case Study #1: A 37-year-old female with intractable localization-related epilepsy returns for a follow up. Since her last visit, her seizures have decreased but she is still having 1-2 focal unaware seizures per week. She does not feel the VNS firing. You decide to change VNS settings. The current is changed from 0.5 ma to 0.75 ma. The On Time is changed from 14 seconds to 7 seconds. The Off Time is changed from 3 minutes to 1.8 minutes (3 parameter changes). All other settings are left the same CPT CPT (if face-to-face time > 31 minutes) (no time threshold) 0.73 VNS Case Study #2: A 37-year-old female with intractable localization-related epilepsy returns for a follow up. Since her last visit, her seizures have decreased but she is still having 1-2 focal unaware seizures per week. She does not feel the VNS firing. You decide to change VNS settings. The current is changed from 0.5 ma to 0.75 ma. The On Time is changed from 14 seconds to 7 seconds. The Off Time is changed from 3 minutes to 1.8 minutes. The magnet-activated current is increased from 0.75 to 1.00 ma (4 parameter changes) CPT (s) CPT (if face-to-face time > 76 minutes) = (no time threshold) 0.97

3 Deep Brain Stimulation (DBS) 2018 CPT Descriptor Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour each additional 30 minutes after first hour NEW 2019 CPT Descriptor Electronic analysis of implanted generator/transmitter (eg, 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 generator/transmitter programming, first 15 minutes faceto-face time with physician or other qualified health care professional with brain generator/transmitter programming, each additional 15 minutes face-toface time with physician or other qualified health care professional The following table has been added to the 2019 CPT Book to assist with correct reporting of brain neurostimulator analysis and programming services. Physician or Other Qualified Health Care Professional Face-to- (s) Face Time for Brain Neurostimulator Analysis with Programming Less than 8 minutes Not reported 8-22 minutes x minutes x x minutes x x minutes x x 3 68 minutes or longer Add units of 95984

4 DBS Case Study #1: A 55-year-old male presents for follow-up for Essential Tremor. He is one-year post-implantation with DBS, and his treatment has been very effective. You saw him last 1 month ago, at which time you reduced his voltage from 3.0V to 2.5V in an exploratory effort to extend his battery life. Unfortunately, this change has left him with slight titubation and vocal tremor. You return to his prior settings, 3.0V. The discussion of his symptoms and adjustment to his DBS system required 10 minutes of your time CPT CPT 2019 Not reportable (face-to-face time is < 31) N/A DBS Case Study #2: A 63-year-old woman with Parkinson s disease complicated by motor fluctuations has undergone bilateral DBS electrode placement last month. She now presents for initial programming. After baseline examination, DBS programming is done by an initial mapping procedure where each electrode is selected in turn and tested by gradual increase in voltage while assessing for effects and side-effects. A range from 0 to 4-6 volts is tested, depending on side effects found during programming. After mapping, the best left and right-side electrode and voltage combination is selected and confirmed. Total face-to-face time with DBS programming is 70 minutes CPT CPT , 3 units = 4.11

5 DBS Case Study #3: A 14-year-old male presents with an idiopathic, presumed genetic dystonia. He is 3 months post-implantation with DBS, and his dystonia is still markedly impairing despite some improvements. He also has new symptoms that his family worries may be side effects of stimulation: mild vertigo and a dull headache that has been persistent since your last therapy change, one month ago. Voltage is reduced from 3.0V to 2.0V, which (after he equilibrates to this setting change) resolves his headache and vertigo. However, his dystonic gait has returned to near its pre-surgical severity. His contorting iliopsoas spasm is much worse on the left, leading you to focus on his right sided contacts. Contact 2 is added to his prior setting (C+, 1-) which leads to subjective improvement in the sensation of pulling, but an immediate return of his headache. Frequency is decreased from 130Hz to 90Hz, with improvement in his headache. You return him to the waiting room for observation for 30 minutes, after which you repeat his tone and gait examination. His dystonia control is as good as when he arrived, and his headache and vertigo have resolved. Device is reprogrammed with backup settings and plan to see him again in one month for further adjustments. Total face-to-face time is 90 minutes CPT = CPT , 5 units = 4.91