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Neurology & Pain Management Coding Alert

Get the Jump on CPT 2006 NCS Guidelines
Report 95900, 95903 and/or 95904 only once when you stimulate multiple sites on the same n... Read more
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Keep This List Handy for Easy NCS Coding
Save yourself the trouble of thumbing through the CPT manual by keeping this list nearby. ... Read more
Get the Straight Answers on ENG and VNG Allowable Units
Reporting 92546 for standard ENG testing?  AMA says not so fastIf you-re confused abo... Read more
News You Can Use:
Nerve Blocks Can Block Your Chemodenervation Payment
New NCCI edits also restrict reconstruction and brain imagingIf you-re thinking of reporti... Read more
READER QUESTIONS:
Secure Pay for Disability Assessments
Question: I have a patient who is applying for early disability retirement. I have spent f... Read more
READER QUESTIONS:
Watch 3-Part Epidurography Criteria
Question: How should I code a visit that included a trigger point injection and epidurogra... Read more
READER QUESTIONS:
Confirm Spinal Block Location for Fluoro Code
Question: Can I report fluoroscopy in conjunction with pain management blocks? If so, what... Read more
READER QUESTIONS:
Breathe Easy With CPAP Follow-up Coding
Question: When I interpret sleep studies (CPAP), I have to reprogram or interrogate the ma... Read more
Readers Questions:
Avenox: Still Under "Chemo" Rules
Question: I was told by our Avonex representative that I should be billing the chemo... Read more
You Be the Coder:
Brainstorm Ideas for Reporting IDEA
Question: How can we code for IDEA? We have been using an unlisted-procedure code, but it'... Read more
CPT 2006 Answers Your Call for Chemodenervation Guidance Codes
You can choose between needle EMG and muscle stimulation guidance Great news for neurolog... Read more
3 New Codes Increase Your Nerve Destruction Options in 2006
For unilateral injections, look to modifier 52 CPT 2006 will bring with it three yet-to-b... Read more
64613 Descriptor Undergoes Minor Revisions
In an effort to clarify appropriate application of chemodenervation procedure 64613, CPT 2... Read more
QST Gains Category III Status
Report testing per extremity, not per individual site The AMA will designate five new Cat... Read more
Category III Codes Describe Emerging Technologies
When a Category III code exists to describe a service or procedure, you must use that Cate... Read more
Consult Coding Receives a New Year Makeover
You-ll treat -second opinions- like any other E/M service The AMA will streamline E/M cod... Read more
Success With Modifier 25 Is as Easy as 1, 2, 3
Separate documentation must stress the distinct nature of the E/M service Revised explana... Read more
Reader Questions:
Base Bilateral TPI on Number of Muscles
Question: I know Medicare doesn't recognize modifier 50 (Bilateral procedure) for trigger ... Read more
Reader Questions:
Pinpoint Nerve Block Code by Anatomy
Question: Please tell me what to report for:  Procedure performed: supraorbital nerve... Read more
Reader Questions:
Stray Away From Modifier 50 With 95870
Question: How should I report limited muscle study EMG for the left and right arms? Can I ... Read more
You Be the Coder:
Is E/M Separate With Avonex Injection?
Question: What is the proper coding for Avonex injections performed in the office? Can I r... Read more
Continuous Infusion Codes Are the Way to Go For Pain Pump Claims
Include daily drug management in your injection serviceWhen reporting so-called "pain pump... Read more
Continuous Infusion Pain Pump Basics
Continuous infusion pain pumps provide a constant flow of local anesthetic to a targeted a... Read more
Prevent 3 Common Mistakes On Your Medicare Claims
Take care not to report codes included in services you've already claimedMedicare payers c... Read more
Shape Up Your Inpatient Consults in 4 Easy Steps
You can report a new initial consult for each inpatient stayIf you're having a hard time d... Read more
Consults 101:
What Your Documentation Must Show
Before you even consider reporting any consult service 99241-99275, you must meet three re... Read more
READER QUESTIONS:
Insurers Won't Pay for Family Counseling
Question: Is there any way we can charge for a visit to discuss a patient's situation if t... Read more
READER QUESTIONS:
'3-Year Rule' Applies to Practice, Not Physician
Question: A patient sees a neurologist in our group practice. Over two years later the pat... Read more
READER QUESTIONS:
Verify Guidelines for Pulsed Radiofrequency
Question: What code should I report for pulsed radiofrequency? I have information stating ... Read more
READER QUESTIONS:
Append 59 to Component Code
Question: When my neurologist performs 95900 and 95903 on different nerves, should I add m... Read more
READER QUESTIONS:
Nonphysician Staff Can Perform History Element
Question: Must the neurologist take a patient's history, or can a nurse or other nonphysic... Read more
READER QUESTIONS:
Stick With 1 Unit of 95869
Question:  Our neurologist conducted electromyography study if the thoracic paraspina... Read more
You Be the Coder:
Would Same-Side Limbs Call for Modifier 50?
Question: Should I use modifier 50 with 64614 if the neurologist treats the right leg and ... Read more
5 Tips Give You the Lowdown on Lumbar Injections
The agent the doc injects can give clues to proper coding When coding injections or in... Read more
CMS Denials, Part I:
Avoid the Most Common Reason CMS Denies Your Claim
Replacing your coding manuals annually is one way to help Combating denials means coopera... Read more
Avonex Update:
Ditch 90782, Reach for G0355 For Injections
You'll still need direct supervision If your neurology practice provides in-office inject... Read more
Clarification:
Can't Call Chemodenervation 'Permanent'
In the September issue of Neurology Coding Alert, an article titled -5 Tips Give You the L... Read more
Reader Questions:
Don't Forget 25 With Critical Care
Question: My local Medicare payer has recently started denying critical care services, say... Read more
Reader Questions:
95937 Describes NMJ Testing
Question: How should I report a repetitive study using an EMG machine? The neurologist say... Read more
Reader Questions:
Acupuncture Claims May Require Leg Work
Question: We're receiving rejections from Blue Cross Blue Shield, 1199, United Health Care... Read more
Reader Questions:
Stick With 1 Unit of 95869
Question: Our neurologist conducted electro-myography study of the thoracic paraspinal mus... Read more
Reader Questions:
Number of Muscles Tested Makes EMG 'Limited'
Question: What are the guidelines for reporting electromyography codes 95860-95864? How do... Read more
You Be the Coder:
What Makes a Comprehensive Audio Study?
Question: How do comprehensive (92585) and limited (92586) audio studies differ?Washington... Read more
More Than 2 Dozen Changes Slotted for Sleep Disturbance Diagnoses in 2006
ICD-9 brings you detailed codes to describe insomnia, apnea and more If you've had troubl... Read more
The AMA Weighs in on Less-Than-24-Hour EEG
Anything under 12 hours calls for 95951-52 The AMA now says that if you are reporting 959... Read more
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Keep the New Sleep Disorder Codes at Your Fingertips
Here's a convenient list of all the new-for-2006 sleep disorder diagnoses. You can use thi... Read more
Don't Wait Any Longer to Master Revised Stroke Diagnoses
Turn to the 438.xx series if the neurologist is managing late effects of stroke You may t... Read more
CMS Changes 'Incident-To' Guidelines - Again
Assume that ordering and supervising physician must be the same person Neurology practice... Read more
Coding Briefs:
Note New Dx, Revised Fee Schedule for the Months Ahead
For all you busy neurology practices trying to keep up with the latest coding facts, here ... Read more
Coding Quick Update:
Time to Call on CPT for Medicare PET Scans
You can finally ditch the HCPCS G codes when reporting positron emission tomography (PET) ... Read more
Reader Questions:
Avonex Injections Are Reimbursable for MS
Question: I've heard conflicting information on Avonex when used to treat MS. Will insurer... Read more
Reader Questions:
Ease a Headache With Botox Code 64612
Question: My neurologist injected 50 units of Botox around the forehead and scalp for a pa... Read more
Reader Questions:
Supply Costs Included in EMG Codes
Question: Can we bill separately for supplies in addition to the standard CPT codes when a... Read more
Reader Questions:
Leg Weakness Leads to General Codes
Question: What is the appropriate diagnosis code for "leg weakness"?Kansas Subscriber Ans... Read more
Reader Questions:
There's No Modifier for Incident-To
Question: Should I use a modifier when reporting services provided "incident-to" the neuro... Read more
Reader Questions:
Don't Count on Cash for Educational Materials
Question: Is there a way we can offset the cost of educational materials, pamphlets, etc.,... Read more
Reader Questions:
Payers Might Request 95951 Documentation
Question: We recently submitted a claim for 95951. Our billing service states that they ca... Read more
You Be the Coder:
Is Guidance Included in Chemodenervation?
Questions: Recently, I submitted a claim to Medicare for chemodenervation injection (64614... Read more
More Isn't Necessarily Better for EDX Testing
Bilateral conditions may require the neurologist to forego recommended testing limitsIf yo... Read more
Watch Your Claims Frequency For EDX Testing
Rapidly developing diseases may give cause for more frequent testsWhen reporting electrodi... Read more
Correction:
Turn to 64614 to Treat Spastic Hemiparesis
The February 2005 issue of Neurology Coding Alert contained an error.The answer to the rea... Read more
Choosing an E/M Level Is Easier With These 3 Q&A's
You can receive MDM credit for test orders, even if the patient refuses the testIf you wan... Read more
READER QUESTIONS:
Time Matters for Complex Neurostimulators
Question: Should I consider time when choosing a neurostimulator programming code?New York... Read more
READER QUESTIONS:
Written Consult Request Isn't Mandatory
Question: We've heard conflicting information about the requirement for a written request ... Read more
READER QUESTIONS:
Observation Status Is Outpatient
Question: When providing a consult for a patient admitted to observation, should we report... Read more
READER QUESTIONS:
Fluoroscopy Matches With Diskography Injection
Question: Can I report 76005-26 with 62290?South Carolina Subscriber Answer: You'll almos... Read more
READER QUESTIONS:
Master Diagnoses for Facet Joint Injections
Question: Will I have trouble receiving reimbursement for facet joint injections 64470-644... Read more
READER QUESTIONS:
Call on -50 for Bilateral H-Reflex
Question: Are codes 95934 and 95936 unilateral or bilateral? Can I charge extra if the phy... Read more
READER QUESTIONS:
More Than 3 EMGs May Mean Difficulties
Question: Can I report one unit of 95861, two units of 95900, and three units of 95904 tog... Read more
You Be the Coder:
Can You Report Perception Threshold Testing?
Question:  Is there a code to report current perception threshold testing?  I ca... Read more
Make Sleep Study/Polysomnography Coding as Easy as 1, 2, 3
Stick with attended studies to ensure paymentIf you're reporting polysomnography (95808-95... Read more
5 Facts to Ease Your Facet Joint Injections Claims
Count levels treated, not injections, for 64470-64476For facet joint injections (64470-644... Read more
Here's How to Collect for Apokyn-Related Services
Shifting costs to patients may be the only way to avoid losses If your neurology practice ... Read more
Recoup Pay for Fluoroscopic Guidance With Nerve Blocks
If your neurologist provides the fluoroscopic guidance that allows her to place the needle... Read more
News in Brief:
AMA Could Implement Its Own Correct Coding Initiative
Neurology practices may soon face an additional layer of coding guidelines, because the Am... Read more
READER QUESTIONS:
Report Only Services the Neurologist Provides
Question: How can we handle cases in which the patient supplies the drug but asks the neur... Read more
READER QUESTIONS:
Previous Hospital Care May Affect E/M
Question: A provider insurance representative recommended at an in-house seminar that if o... Read more
READER QUESTIONS:
Infusion Requires Direct Supervision
Question: Can our nurse provide Solu-Medrol to patients in the office, and, if so, must th... Read more
READER QUESTIONS:
95957 Can Follow 95950
Question: When billing for an office ambulatory EEG (95950), can we also bill 95957 for th... Read more
READER QUESTIONS:
Include Monofilament Testing in E/M
Question: What is the appropriate code to describe monofilament peripheral neuropathy test... Read more
You Be the Coder:
How Do Facet Joint and Epidural Injection Differ?
Question: How can I distinguish facet joint injections (64470-64476) from epidural blocks ... Read more
Pin Down Your Chances for Acupuncture Reimbursement With Better Documentation
Medicare won't pay, but an ABN can save reimbursement If you're reporting acupuncture cod... Read more
Watch Your E/M Coding With Mental Status Exams
CMS guidelines prohibit separate billing When you code a mini-mental status exam (MMSE),... Read more
Confused by 'Functional Muscle Group'? Here's the Scoop
Think in terms of 'body parts,' not individual muscles When you're reporting chemodenerv... Read more
Here's How to Differentiate Mental Status Exams From Mini-MSE
The MMSE (mini-mental status exam) is a 30-element examination, originally created to prov... Read more
Don't Let Drug Waste Shrink Your Bottom Line
Schedule multiple Botox treatments to combat short shelf life Botox is expensive, and if ... Read more
News for Coders:
Biogen Idec and Elan Suspend Tysabri
Neurology practices offering, or planning to offer, Tysabri infusions for multiple scleros... Read more
Reader Questions:
Destruction Codes Describe RFTC
Question: How can I report radiofrequency thermal coagulation (RFTC) to disable the nerves... Read more
Reader Questions:
Look to CPT for Facet Joint Instructions
Question: Should I use modifier -50 for bilateral facet joint injections (64470-64476)? If... Read more
Reader Questions:
Call on 95928/95929 for Central Motor Tests
Question: How should I code central evoked motor studies?California Subscriber Answer: Fo... Read more
Reader Questions:
Once per Session Is Enough for 95869
Question: May I report multiple units of 95869 for testing multiple spinal levels? Can I a... Read more
Reader Questions:
Skip 64565 for NMES
Question: Can I code for neuromuscular electrical stimulation (NMES)?Colorado Subscriber ... Read more
Reader Questions:
Turn to 95904 for 'Mixed' Nerve
Question: What is a "mixed" nerve? How should I report nerve conduction studies for a mixe... Read more
Reader Questions:
Treat 'Meet and Greet' as a Courtesy
Question: Recently, our neurologist met with a prospective patient for a 20-minute "meet a... Read more
You Be the Coder:
Is Equipment All That Matters for -26?
Question: I've always thought that I can bill for both the professional and technical comp... Read more
Coding Tysabri? Here's the Best Information Available So Far
Choose from C9399, C9126 or J3590 for drug suppliesAs with most infusion drugs, you should... Read more
Don't Be Thrown by 'Chemo' in Infusion Descriptor
Although the descriptors for G0359 and G0360 specify "chemotherapy administration," these ... Read more
Private Payers Pose Unique Challenges for Tysabri
CPT codes 90780/90781 for infusion are a possibility The best way to know how to report Ty... Read more
Case Study:
4 Steps Make Intraoperative Monitoring Easy
Clarify your questions with this aneurysm clipping exampleWhen reporting intraoperative mo... Read more
4 Tactics for Reporting EMGs With No New Diagnosis
Raw data that proves medical necessity sustains your claims If your neurologist didn't fin... Read more
READER QUESTIONS:
Same Stay = Follow-up Consult
Question: Our neurologist was called for an inpatient consult for a head injury patient. T... Read more
READER QUESTIONS:
Skip Modifier -50 for NCS
Question: How should I code nerve conduction studies when the neurologist tests four nerve... Read more
READER QUESTIONS:
Choose From 95925-95927 for SSEP
Question: Which codes should I use for SSEP?Kansas Subscriber Answer: You should choose f... Read more
READER QUESTIONS:
Tensilon Testing Does Have Its Own Code
Question: Does Tensilon testing have a dedicated code(s) and, if so, what is it?South Caro... Read more
READER QUESTIONS:
Lay Off Unlisted-Procedure Codes for IDET
Question: Recently, I filed a claim for intradiskal electrothermal therapy (IDET) using un... Read more
READER QUESTIONS:
Payers May Treat Autonomic Testing as Investigational
Question: Are autonomic testing codes (95921, 95922 and 95923) mutually exclusive? I've be... Read more
You Be the Coder:
Which Code for Pars Interarticularis Injection?
Question: Which codes apply to a pars inter-articularis defect facet injection? The neurol... Read more
3 Ways to Make the Most of Injection Claims
Document the muscle(s) the neurologists treats for clean injection codingYou may be submit... Read more
Complexity Justifies More Treatment for Facet Joints
Be prepared to appeal denials if you bill trigger points alongside nerve blocksIf your neu... Read more
Medical Necessity Starts With a Proper Diagnosis
'Specificity' is the watchword for ICD-9 codingThe best way to fight denials based on inco... Read more
Don't Fall Victim to This ICD-9 Coding Myth
You can (and often should) use signs and symptoms as a primary diagnosisHere's a coding ru... Read more
NCCI Quick Update:
Motor EPs and EMGs Now Included in Surgeries
The latest National Correct Coding Initiative (NCCI) has released hundreds of edits involv... Read more
READER QUESTIONS:
Don't Count on 'After-Hours' Pay
Question: Will Medicare pay extra for the neurologist seeing a patient for an unscheduled ... Read more
READER QUESTIONS:
Turn to HCPCS for Current Perception Threshold
Question: How should we report current perception threshold testing? The machine manufactu... Read more
READER QUESTIONS:
Use Surgery Diagnosis for Intraoperative EMG
Question: My neurologist goes into the operating room to monitor a patient's nerves during... Read more
READER QUESTIONS:
How to Choose Between Hospital Follow-up Codes
Question: When the neurologist performs an inpatient consult, I bill 99251-99255. Should I... Read more
READER QUESTIONS:
Don't Count Out Conscious Sedation for 2005
Question: I've heard that CPT will begin bundling conscious sedation to MRIs, CT scans and... Read more
You Be the Coder:
What's the Code for Aphasia Assessment?
Question: How can we report time the neurologist spends assessing for aphasia (784.3)? Was... Read more
Your 4 Most Common EEG Questions Answered
Counting the hours and minutes provides one key to accurate coding Electroencephalograms ... Read more
Good News for Neurologists
2005 fee schedule brings a 1.5 percent increase across the board CMS has unveiled its "Re... Read more
Time Equals Money for E/M Coding
Proper documentation of time spent  can increase your level of service You may be s... Read more
Don't Get Derailed by Supervision Requirements
Understand supervision levels and note physician involvement for success To demonstrate t... Read more
Reader Questions:
Time, Documentation Critical to 99291 Payment
Question: In the afternoon, our neurologist saw a patient for 30 minutes on the hospital f... Read more
Reader Questions:
Look to -32 for Confirmatory Consult
Question: Recently, a private (non-Medicare) insurer requested that our neurologist provid... Read more
Reader Questions:
Select Your Dx Carefully for Video EEG
Question: How should I report video EEG? I've had trouble with these claims facing denial.... Read more
Reader Questions:
Use Alternative for Glossopharyngeal Nerve Code
Question: How should I code a glossopharyngeal nerve block?Montana Subscriber Answer: The... Read more
Reader Questions:
Check Date When Coding Admission From ED
Question: When our neurologist admits a patient to the hospital after-hours from the emerg... Read more
Reader Questions:
Call on Destruction Code for Hemiparesis Treatment
Question: What is the proper code for injecting different forearm muscles (one arm only) t... Read more
You Be the Coder:
The Global Period for Unlisted-Procedure Codes
Question: Does Medicare assign a global period for unlisted-procedure codes? For instance,... Read more
Take a Closer Look at Digital EEG Analysis
You can report 95957 with 95951/95953, but meeting the requirements may be tougher than y... Read more
Reporting t-PA? Don't Forget E/M Codes
37195 isn't enough for payment Unless your neurologist wants to give her services away, y... Read more
No Admission for t-PA? Look Instead to Consults
If another physician provides initial care for the stroke victim (in the emergency departm... Read more
Red Flag Alert! CMS Puts Modifier -59 Claims Under Scrutiny
If documentation won't support a separate service, don't unbundle If you're using modifie... Read more
Reader Questions:
Use Physician Coding for Tech Testing
Question: How should we bill if a technician, rather than the neurologist, conducts diagno... Read more
Reader Questions:
Choose 99235 for Physician Who Examines Patient
Question: Dr. Smith was on-call and admitted a patient to the hospital. On the same day, o... Read more
Reader Questions:
Select Unlisted-Procedure Code for QST
Question: Which is the proper code to describe quantitative sensory testing?Vermont Subscr... Read more
Reader Questions:
Assign a Single Date to Medicare Claims
Question: Our neurologist performed subsequent hospital care over the course of four days,... Read more
You Be the Coder:
Myobloc Isn't Botox
Question: How should I report Myobloc injections? Is Myobloc just another name for Botox?C... Read more
Available Years:  2005  2004  2003  2002  2001  2000  1999