Deep Brain Stimulation Coding in CPT
Deep Brain Stimulation (DBS) is an elective surgical procedure designed to alleviate the motor symptoms of movement disorders like essential tremor, Parkinson’s disease, and dystonia. While it doesn’t offer a cure for the underlying neurological conditions, DBS has demonstrated its 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.
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 Benefited by Deep Brain Stimulation
Deep brain stimulation (DBS) treats patients with movement disorders such as essential tremor, Parkinson’s disease, and dystonia. It can also treat obsessive-compulsive disorder and epilepsy.
Common symptoms for each disease type are:
- Essential Tremor
- Tremor that occurs during daily activities such as writing or drinking
- Parkinson’s Disease
- Tremor
- Bradykinesia (slowing down of movement)
- Stiffness
- Abnormal walking
- Dystonia
- Involuntary muscle contractions that occur during specific actions (e.g., writing)
- Muscle contractions that worsen with stress, fatigue, or anxiety
- Epilepsy
- Temporary confusion
- A staring spell
- Loss of consciousness
- Uncontrollable jerking movements of the arms or legs
- Emotional responses such as fear, anxiety, or déjà vu
- Obsessive-compulsive Disorder
- Fear of germs or contamination
- Aggressive thoughts toward others or one’s self
- Having things in symmetrical or perfect order
- Excessive cleaning or handwashing
- Compulsive counting
- Checking things repeatedly, such as making sure the oven is off or the door is locked
Components of a DBS System
According to the National Institue of Neurological Disorders and Stroke, a DBS system consists of these three integral components:
- 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. Depending on the disorder, the electrode tip is positioned within a specific brain area.
- 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), or the “battery pack,” is usually implanted under the skin near the collarbone. It may sometimes be implanted lower in the chest or under the skin over the abdomen.
Implantation and Steps of DBS
According to MedlinePlus, DBS surgery usually involves one or two stages in which two separate surgeries are performed. Stage 1 is performed on children under general anesthesia. All other patients receive local anesthesia for this stage.
Preoperative Evaluation
Before surgery, patients may undergo neurological and psychological assessments to determine their suitability for DBS. Brain imaging, such as MRI or CT scans, is conducted to pinpoint the right brain area for symptom relief.
Stage 1: Surgical Implantation
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
Stage 2 is done under general anesthesia. When this stage of surgery is performed 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.
After the Procedure – Programming
Following a period of healing, a neurologist activates the neurostimulator and adjusts the patient’s stimulation, tailoring treatment to the patient’s needs. This process is called programming.
CPT Coding for Deep Brain Stimulation
Several CPT codes are listed to describe the various steps of DBS, i.e., implantation of the electrodes, implantation of the pulse generator, intraoperative monitoring and programming of the electrodes, revision and removal of the electrodes, and postoperative neuro-programming.
Lead and Implantable Pulse Generator (IPG) Codes
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.
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 ; 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).
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 ; with use of intraoperative microelectrode recording; each additional array
Like 61864, 61868 is an add-on code. It must be reported with 61867.
61885 Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
61886 ; 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.
Revision or Removal of Lead and Pulse Generator Codes
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)
Neurostimulator Analysis Programming Codes
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 ; 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.
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.
CPT: 95970
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
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.
CPT: 95983 x 1, 95984 x 3
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.
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.
The following information from the CPT coding manual explains the face-to-face time spent with a physician or other qualified healthcare professional to analyze and program a deep brain neurostimulator. The appropriate CPT codes are listed based on the time spent.
Codes 95983 and 95984 are used to report for electronic analysis with programming of an implanted brain neurostimulator pulse generator/transmitter.
LOCATE AND VERIFY
We can find the 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)
Our correct codes are 95983 x 1 and 95984 x 3.
CPT codes 95983 and 95984 are in the same section of the CPT coding manual as CPT 95970. The table below shows 53-67 minutes of brain neurostimulator analysis and programming services as 95983 x 1 + 95984 x 3.
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.
Short Video on Deep Brain Stimulation
Here is a 3-minute video explaining how a DBS procedure is performed.
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