Deep Brain Stimulation Coding in CPT: Maximizing Your Understanding
** This article was reviewed and updated on February 26, 2024. **
Deep Brain Stimulation (DBS) is a surgical intervention aimed at reducing motor symptoms associated with movement disorders such as essential tremor, Parkinson’s disease, and dystonia. While not offering a definitive cure for the underlying neurological conditions, DBS has demonstrated remarkable potential in enhancing patients’ quality of life by reducing symptoms such as tremors, rigidity, and bradykinesia—especially when traditional medications fail to provide relief. Follow along to explore the components of the DBS system, the procedural stages, and the pertinent CPT codes essential for reporting each phase. Additionally, to enhance your understanding, a short video explaining the procedure and two coding case examples are provided.
Prevalence of Deep Brain Stimulation
According to the American Association of Neurological Surgeons, movement disorders affect hundreds of thousands of people worldwide, and DBS has been used to treat over 160,000 people for various neurological conditions.
Conditions Treated by DBS
DBS treats patients with movement disorders such as essential tremor, Parkinson’s disease, dystonia, epilepsy, and obsessive-compulsive disorder. Each condition manifests as distinct symptoms, ranging from tremors and bradykinesia (slow movement) to involuntary muscle contractions and cognitive disturbances.
Components of a DBS System
The National Institute of Neurological Disorders and Stroke reports that a DBS system consists of these three integral components: the electrode (or lead), lead extension, and implantable pulse generator (IPG). These components work together to deliver targeted electrical stimulation to specific brain regions, thereby regulating pathological neuronal activity and improving symptoms.
The placement of these components is as follows:
- The electrode, or lead, is a thin, insulated wire that is inserted through a small opening made in the skull and implanted in the brain. The electrode tip is positioned within a specific brain area depending on the disorder.
- The lead extension, an insulated wire, is passed under the skin of the head, neck, and shoulder, connecting it to the implantable pulse generator.
- The implantable pulse generator (IPG), also known as the neurostimulator or battery pack, is usually implanted under the skin near the collarbone. However, sometimes it may be implanted lower in the chest or under the skin over the abdomen.
Surgical Procedure and Implantation
DBS surgery typically involves one or two stages in which two separate surgeries are performed. As MedlinePlus states, the initial stage encompasses the surgical implantation of electrodes into predetermined brain regions, followed by the subsequent implantation of the neurostimulator in a separate procedure. These steps demand careful planning, guided by preoperative evaluations and neuroimaging techniques to ensure optimal electrode placement.
Stage 1: Surgical Implantation of Lead
Stage 1 is performed on children under general anesthesia, while all other individuals receive local anesthesia. The surgeon likely shaves a bit of hair from the patient’s head before placing the head in a special frame, using screws to keep it in place. Numbing medicine is applied where the screws contact the scalp and also at the site where the surgeon will open the skin with a drill. Once open, the lead is placed into specific areas of the brain. If both sides of the brain are being treated, the surgeon will make an opening on each side of the skull and insert two leads. Electrical impulses may need to be sent through the lead to ensure it is connected to the specific brain area responsible for the symptoms.
Stage 2: Neurostimulator Implantation With Extension Wire
Stage 2 is done under general anesthesia. When this stage of surgery is performed, it is based on the area in the brain where the stimulator will be placed. The surgeon incises the skin, usually just below the collarbone, and implants the neurostimulator. The extension wire is then tunneled under the skin of the head, neck, and shoulder and connected to the neurostimulator. The incision is then closed.
Once the DBS system is connected, electric pulses travel from the neurostimulator, along the extension wire, to the lead, and into the brain. These pulses block the electrical signs that cause the symptoms of certain diseases.
CPT Coding for Deep Brain Stimulation
Several CPT codes are listed to describe the various aspects of DBS, including electrode implantation, pulse generator insertion, pulse generator revision or removal, and postoperative programming.
Codes for Implantation of Neurostimulator and Electrodes
Neurostimulators may include one array or multiple arrays. A single array stimulator has one port that connects to one lead. On the other hand, a multiple-array stimulator has two or more ports to which two or more leads can be connected.
When these neurostimulators and electrodes are implanted without the use of intraoperative microelectrode recording, they are reported with one of the following codes:
- 61863, Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array
- 61864, Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array
61864 is an add-on code and must be used in conjunction with 61863.
Implantation of a single array neurostimulator without recording is reported with 61863. Placement of a multiple array neurostimulator without recording consisting of three ports is reported with 61863 (first array) and 61864 x 2 (each additional array).
Neurostimulators and electrodes implanted with the use of intraoperative microelectrode recording are assigned with one of the following codes:
- 61867, Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array
- 61868, Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional array
Like 61864, 61868 is an add-on code. It must be reported with 61867.
Codes for Pulse Generator Insertion or Replacement
Insertion or replacement of a neurostimulator pulse generator is reported with one of the following codes based on whether the generator is connected to one or more electrode arrays:
- 61885, Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
- 61886, Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays
If bilateral cranial neurostimulator pulse generators are implanted, one on each site with its own lead, report 61885 or 61886 with modifier -50.
Codes for Revision or Removal of Leads and Pulse Generator
Report revision or removal of the leads/electrodes or pulse generator or receiver based on the following codes and descriptors:
- 61880, Revision or removal of intracranial neurostimulator electrodes
- 61888, Revision or removal of cranial neurostimulator pulse generator or receiver
Do not report 61888 in conjunction with 61885 or 61886 for the same pulse generator.
Codes for Postoperative Programming
Electronic analysis of the pulse generator/transmitter is reported with codes according to without programming, or with programming. Programming is further classified to time and must be face-to-face with a physician or other qualified health care professional. These codes include:
- 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
- 95983, 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 neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
- 95984, 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 neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional
Several sessions with the patient may be necessary for electronic analysis with or without programming to determine the best programming parameters.
Short Video on Deep Brain Stimulation
Here is a 3-minute video explaining how a DBS procedure is performed.
Example Cases and Coding Exercises
Review the following case examples and see if you can assign the correct CPT codes based on what you have learned in this article. The answers and rationales are provided below.
Coding Exercise #1
A 62-year-old patient with Parkinson’s disease had a deep brain neurostimulator inserted three weeks ago to fight the bradykinesia from Parkinson’s disease. He is still experiencing slow movements and presents today for a generator check without programming.
Coding Exercise #2
A patient with complications of motor fluctuations due to essential tremor had bilateral deep-brain stimulation electrode placement three weeks ago. Today he presents for initial programming. A baseline examination is performed along with DBS programming using an initial mapping procedure. Each electrode is tested by gradually increasing the voltage from 0 to 4-6 while observing for any changes and side effects. Once the mapping is complete, the best right and left side electrode and voltage combination is chosen and verified. The total face-to-face time spent on DBS programming is 60 minutes.
Answers to Coding Exercises
Coding Exercise #1
Answer: 95970
Rationale: The documentation states that the provider tested the implanted brain neurostimulator pulse generator. A generator check analyzes the device to ensure it is working correctly. No programming was done.
Locate and Verify:
In the CPT Index, we can look under Neurostimulators/Brain/Electronic Analysis 95970, 95983, 95984. In the Tabular listing, we can verify the correct code as:
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.
Code 95970 describes a subsequent electronic analysis of a previously implanted generator and should not be reported at the time of generator insertion.
CPT code 95970 can be found in the Medicine section of the CPT coding manual under Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming Procedures (95970, 97971, 95972, 95976, 95977, 95983, 95984).
According to the CPT coding guidelines:
- CPT code 95970 should not be reported with the following codes during the same operative session: 43647, 43648, 43881, 43882, 61850, 61860, 61863, 61864, 61867, 61868, 61880, 61885, 61886, 61888, 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 64553, 64555, 64561, 64566, 64568, 64569, 64570, 64575, 64580, 64581, 64585, 64590, and 64595.
- CPT code 95970 should not be reported with 95971, 95972, 95976, 95977, 95983, and 95984.
- Codes 95971 and 95972 describe electronic analysis with simple or complex programming of the neurostimulator pulse. generator/transmitter implanted in the spinal cord or peripheral nerve.
- Codes 95976 and 95977 describe electronic analysis with simple or complex programming of the neurostimulator pulse generator/transmitter in the cranial nerve.
- Codes 95983 and 95984 describe electronic analysis with programming of the neurostimulator pulse generator/transmitter implanted in the brain for the first 15 minutes and for each additional 15 minutes.
Coding Exercise #2
Answer: 95983 x 1, 95984 x 3
Rationale: The DBS is already in place; analysis and programming are done here. Programming involves setting the parameters to generate the electrical pulses for stimulation optimally. The total time spent on programming was 60 minutes.
Locate and Verify:
We can find the correct code for this procedure by looking in the CPT Index under Neurotimulators/Implanted Neurostimulator Pulse Generator/Transmitter/Electronic Analysis/with Programming 95971, 95972, 95976, 95977, 95983, 95984. In the Tabular listing, we can verify the correct code as:
95983, 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 neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
We are not done, however. CPT code 95983 only covers the first 15 minutes of programming. We also need to assign 95984 for the remaining 45 minutes.
95984, 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 neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)
CPT codes 95983 and 95984 are in the same section of the CPT coding manual as CPT 95970.
The following information from the CPT coding manual shows 53-67 minutes of brain neurostimulator analysis and programming services as 95983 x 1 + 95984 x 3.
Programming may occur in the operating room, postoperative care unit, inpatient, or outpatient setting. Programming a neurostimulator in the operating room is not inherent in the service represented by the implantation code. It may be reported by the implanting surgeon or other qualified healthcare professional when performed.
Per the CPT guidelines:
- CPT code 95984, an add-on code, should be used with 95983.
- It is not reported if the face-to-face time is less than eight minutes.
Conclusion
Deep Brain Stimulation represents a treatment method for managing debilitating movement disorders. By understanding the components of the DBS system, the procedural stages involved, and the guidelines related to DBS interventions, medical coders are equipped to accurately report for the various phases, facilitating excellent patient care and reimbursement practices.
