CPT® Code 95978

Code deleted, see 95983, 95984

Official Description

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

Common Language Description

Deep brain stimulation (DBS) is a neurosurgical procedure that involves the implantation of a neurostimulator device to deliver electrical impulses to specific areas of the brain. This technique is primarily utilized to manage symptoms associated with neurological disorders such as Parkinson's disease, essential tremor, and dystonia. The procedure entails the placement of stimulating electrodes in targeted brain regions, which are then connected to a pulse generator. This pulse generator is typically implanted in a subcutaneous pocket located in the supraclavicular region of the body. The physician is responsible for programming the generator to optimize symptom relief for the patient. As neurological conditions can change over time, it is essential for the pulse generator to be reprogrammed periodically to ensure continued effectiveness. During the initial programming or any subsequent reprogramming sessions, the physician first assesses the overall functionality of the neurostimulator system. Following this verification, the physician interrogates the device to gather data regarding its usage, particularly if it is a reprogramming session. The physician also engages with the patient to discuss their experiences with the device since the last programming, addressing any issues or concerns that may have arisen. Additionally, the physician reviews any medications that the patient is taking in conjunction with the device to determine if adjustments are necessary. Based on this comprehensive evaluation, the physician sets the programming parameters, which include the rate, pulse amplitude and duration, battery status, electrode selectability and polarity, and impedance. The physician then proceeds to program or reprogram the neurostimulator device accordingly. For the first hour of either initial programming or subsequent reprogramming, the appropriate code to use is 95978, while code 95979 should be utilized for each additional 30 minutes of programming or reprogramming.

1. Indications

The electronic analysis and programming of an implanted neurostimulator pulse generator system is indicated for patients with neurological conditions that may benefit from deep brain stimulation. These conditions include:

Parkinson's Disease A progressive neurological disorder characterized by tremors, rigidity, and bradykinesia, which can be alleviated through stimulation of specific brain regions.
Essential Tremor A movement disorder that causes involuntary shaking, often affecting the hands and arms, which can be managed with deep brain stimulation.
Dystonia A movement disorder resulting in involuntary muscle contractions and abnormal postures, which may improve with targeted electrical stimulation.

2. Procedure

The procedure for electronic analysis and programming of the implanted neurostimulator pulse generator system involves several critical steps:

Step 1: Verification of Device Functionality The physician begins by checking the overall functioning of the neurostimulator system to ensure that it is operating correctly. This initial assessment is crucial to confirm that the device is ready for programming.
Step 2: Device Interrogation Once the device's functionality is verified, the physician interrogates the neurostimulator to collect data on its performance and usage. This step is particularly important during subsequent reprogramming sessions, as it provides insights into how the device has been functioning since the last adjustment.
Step 3: Patient Consultation The physician engages with the patient to discuss their experiences with the neurostimulator since the last programming session. This dialogue allows the physician to address any concerns or issues the patient may have encountered, ensuring that the programming meets the patient's needs.
Step 4: Medication Review The physician evaluates any medications the patient is currently taking in conjunction with the neurostimulator. This review is essential to determine if any adjustments to the patient's medication regimen are necessary to optimize treatment outcomes.
Step 5: Parameter Setting Based on the information gathered from the device interrogation, patient consultation, and medication review, the physician sets the programming parameters for the neurostimulator. These parameters include the rate, pulse amplitude and duration, battery status, electrode selectability and polarity, and impedance.
Step 6: Programming or Reprogramming Finally, the physician programs or reprograms the neurostimulator device according to the established parameters, ensuring that the device is tailored to the patient's current therapeutic needs.

3. Post-Procedure

After the programming or reprogramming of the neurostimulator pulse generator, the patient may be monitored for any immediate effects or adjustments needed. It is important for the physician to provide guidance on follow-up appointments to assess the effectiveness of the new settings. Patients may also be advised to keep a log of their symptoms and any changes they experience, which can be valuable for future programming sessions. Regular follow-up is essential to ensure that the neurostimulator continues to provide optimal symptom relief and to make any necessary adjustments based on the patient's evolving condition.

Short Descr	ANALYZE NEUROSTIM BRAIN/1H
Medium Descr	ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR
Long Descr	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
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	T2D - Other tests - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	7 - Other diagnostic nervous system procedures