How To Use CPT Code 95972

CPT 95972 involves the electronic analysis of an implanted neurostimulator pulse generator/transmitter by a physician or qualified healthcare professional, with complex programming changes made as needed. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 95972.

1. What is CPT 95972?

CPT 95972 is a medical billing code used to describe the electronic analysis of an implanted neurostimulator pulse generator/transmitter by a physician or other qualified healthcare professional. This code is specifically used when complex programming changes are made to the device to ensure its proper functioning. Neurostimulator pulse generator/transmitter systems are battery-powered devices designed to deliver electrical stimulation to the brain, spinal cord, or peripheral nerves to treat certain neurological disorders.

2. 95972 CPT code description

The official description of CPT code 95972 is: “Electronic analysis of implanted neurostimulator pulse 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 complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional.”

3. Procedure

The procedure for CPT 95972 involves the following steps:

1. The physician or qualified healthcare professional reviews the patient’s medical history and assesses the need for electronic analysis of the implanted neurostimulator pulse generator/transmitter.
2. The provider checks the system’s programming to ensure correct functioning of the brain, spinal cord, or peripheral nerve neurostimulator.
3. The provider tests various features of the device, such as contact group(s), interleaving, amplitude, pulse width, frequency, on/off cycling, burst, magnet mode, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters.
4. Based on the testing results, the provider makes complex programming changes to the neurostimulator device as needed.
5. The physician or qualified healthcare professional documents the findings and any programming changes made to the device.

4. Qualifying circumstances

Patients eligible to receive CPT code 95972 services are those who have a previously implanted spinal or peripheral (e.g., sacral) nerve neurostimulator pulse generator/transmitter and require electronic analysis and complex programming changes to ensure proper functioning of the device. This may include patients experiencing changes in their neurological symptoms or those who have not had a recent evaluation of their neurostimulator device.

5. When to use CPT code 95972

CPT code 95972 should be used when a physician or qualified healthcare professional performs electronic analysis of a previously implanted spinal or peripheral nerve neurostimulator pulse generator/transmitter and makes complex programming changes to the device. This code is appropriate when the provider needs to ensure the proper functioning of the neurostimulator device and make necessary adjustments to its programming.

6. Documentation requirements

To support a claim for CPT 95972, the following information should be documented:

• Patient’s medical history and reason for the electronic analysis of the implanted neurostimulator pulse generator/transmitter.
• Details of the provider’s assessment and testing of the device, including the features tested and the results of the testing.
• Complex programming changes made to the neurostimulator device, if any, and the rationale for these changes.
• Follow-up care or recommendations for the patient, if applicable.

7. Billing guidelines

When billing for CPT code 95972, it is essential to follow the appropriate billing guidelines and rules. These may include:

• Ensuring that the provider performing the electronic analysis and complex programming changes is a physician or qualified healthcare professional.
• Confirming that the patient has a previously implanted spinal or peripheral nerve neurostimulator pulse generator/transmitter.
• Documenting the necessary information to support the claim, as outlined in the documentation requirements section.
• Using the appropriate modifiers, if needed, to indicate any special circumstances related to the service.

8. Historical information

CPT 95972 was added to the Current Procedural Terminology system on January 1, 1999. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2019.

9. Similar codes to CPT 95972

Five similar codes to CPT 95972 and how they differ are:

• CPT 95970: Electronic analysis of an implanted neurostimulator pulse generator/transmitter without programming changes.
• CPT 95971: Electronic analysis of an implanted neurostimulator pulse generator/transmitter with simple programming changes.
• CPT 95973: Electronic analysis of an implanted neurostimulator pulse generator/transmitter with complex cranial nerve neurostimulator programming.
• CPT 95974: Electronic analysis of an implanted neurostimulator pulse generator/transmitter with brain neurostimulator programming.
• CPT 95975: Electronic analysis of an implanted neurostimulator pulse generator/transmitter with complex brain neurostimulator programming.

10. Examples

Here are 10 detailed examples of CPT code 95972 procedures:

1. A patient with a previously implanted spinal cord neurostimulator pulse generator/transmitter experiencing increased pain undergoes electronic analysis and complex programming changes to improve pain relief.
2. A patient with a sacral nerve neurostimulator pulse generator/transmitter for urinary incontinence undergoes electronic analysis and complex programming changes to optimize device settings for better symptom control.
3. A patient with a peripheral nerve neurostimulator pulse generator/transmitter for chronic migraine headaches undergoes electronic analysis and complex programming changes to address changes in headache frequency and severity.
4. A patient with a spinal cord neurostimulator pulse generator/transmitter for complex regional pain syndrome undergoes electronic analysis and complex programming changes to adjust stimulation parameters for improved pain relief.
5. A patient with a sacral nerve neurostimulator pulse generator/transmitter for fecal incontinence undergoes electronic analysis and complex programming changes to optimize device settings for better symptom management.
6. A patient with a peripheral nerve neurostimulator pulse generator/transmitter for occipital neuralgia undergoes electronic analysis and complex programming changes to address changes in pain intensity and location.
7. A patient with a spinal cord neurostimulator pulse generator/transmitter for failed back surgery syndrome undergoes electronic analysis and complex programming changes to adjust stimulation parameters for improved pain relief.
8. A patient with a sacral nerve neurostimulator pulse generator/transmitter for pelvic pain undergoes electronic analysis and complex programming changes to optimize device settings for better pain management.
9. A patient with a peripheral nerve neurostimulator pulse generator/transmitter for trigeminal neuralgia undergoes electronic analysis and complex programming changes to address changes in pain intensity and frequency.
10. A patient with a spinal cord neurostimulator pulse generator/transmitter for phantom limb pain undergoes electronic analysis and complex programming changes to adjust stimulation parameters for improved pain relief.