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Neurology & Pain Management Coding Alert

Take Care Splitting EEG Into Pro and Tech Components to Fend off Denials
Purchasing power will change the rules for using modifiers 26, TC Reporting modifiers 2... Read more
Get Ready for New Stroke Code With Can't-Miss Insights
Check out what ICD-9 has in store for stroke patients treated with tPA If you code for ... Read more
ICD-9 Coding:
Think 'Likely' Diagnosis Trumps Symptoms? Think Again
Look for these phrases in your neurologist's documentation Typically, your first-listed... Read more
News You Can Use:
What a New AAN Neuralgia Guideline Means for You
Code 350.1 may be treated differently than in the past The American Academy of Neurolog... Read more
Watch for Frequent Signs and Symptoms
Neurology highlights: Signs and symptoms you might encounter more frequently in a neurol... Read more
Reader Questions:
Use a Modifier for Short EEG Studies
Question: My neurologist performed an EEG with video monitoring for eight hours. How sho... Read more
Reader Questions:
Code Right for Stroke Patient Critical Care
Question: How should I code for the critical care of a stroke patient on Medicare? Main... Read more
Reader Questions:
Use +95920 for Some EMGs
Question: Can I use +95920 with EMGs?  Illinois Subscriber Answer: You can use ... Read more
You Be the Coder:
Check ICD-9 for Coding Brain Death
Question: How do I go about coding brain death found by routine EEG? Wisconsin Subscrib... Read more
Breaking News:
Support BPPV Payer Processing With New AAN Guideline
Why CPT 92700 may be your best bet for the Epley maneuver Preparing an unlisted-proced... Read more
Clarify Unlisted Procedure Codes in Your Claims
Use CPT 97530 as a basis for comparison when coding this unlisted procedure Streamline... Read more
Success Story:
EMGs Make the Difference in Billing NCS
Payers are more likely to reimburse 95900, 95903 and 95904 with EMG use Nerve conductio... Read more
Reader Questions:
Choose the Right Botulinum Injection Code
Question: The neurologist that I work for has started to perform injections of Botulinum... Read more
Reader Questions:
Use Add-On Codes for MMSEs
Question: May I code based on time if my neurologist conducts a mini-mental state exam (... Read more
Reader Questions:
Give Credit for Opinions While in the ED
Question: What may I report if our neurologist is asked for an opinion on a patient's co... Read more
Reader Questions:
Report General Weakness with 780.28
Question: How should I code generalized weakness if the neurologist has documented no ot... Read more
Reader Questions:
Don't Code E/M for Prescriptions Only
Question: My neurologist believes there is a code specifically for writing a prescriptio... Read more
You Be the Coder:
Billing Frequency for IOM?
Question: The neurologist that I bill for performs intraoperative monitoring (IOM). Is t... Read more
Take Advantage of Reporting Fluoroscopy With ESIs -- Here's How
Payers hold the key to unlocking medical necessity for these injections It pays to reco... Read more
Match ESI Codes to Proper Vertebrae at a Glance
Remember to watch for transforaminal or interlaminar approach You have a lot of element... Read more
Keep ESI Fluoro and 72275 Separate for Accurate Claims
Don't miss: Epidurography has strict documentation requirements If you aren't familiar ... Read more
Watch 99231 Claims or Risk Audit Troubles
Under-reporting 99232 and 99233 can raise red flags for payers Subsequent hospital care... Read more
Improve Documentation With These 99231-99232 Guidelines
A thumbnail sketch can help prevent over- or under-reporting There are some "shorthand"... Read more
Reader Questions:
Code Your Neurologist's Injections Correctly
Question: When should I report 90772 for injections the neurologist administers? Calif... Read more
Reader Questions:
Code Patient's Location, Not Doctor's
Question: I code for a neurologist who usually sees patients in his office. But one week... Read more
Reader Questions:
Avoid the ADD Label at Your Own Risk
Question: How should I code for a child who is inattentive or has trouble focusing witho... Read more
You Be the Coder:
Separate E/M Visit from TPI?
Question: My doctor wants to start administering trigger point injections (TPIs). May I ... Read more
Here Comes Relief -- Get Ready for More Specific Migraine Coding
Our experts explain why 346.xx changes will cause no pain CMS recently released its pre... Read more
Bone Up on Tysabri Infusion Coding With 3 Surefire Rules
Don't miss out on $40 per 96415 service You need a solid understanding of how to code f... Read more
Be Careful When Coding for Infusions, E/M
About monitoring: Coders often ask about how to report their physician's time spent moni... Read more
Don't Miss Common Infusion Services Dx Codes
Infusion services can be an important aid -- not only in the treatment of multiple scleros... Read more
Reader Questions:
Alleviate Radiofrequency Neurolysis Confusion
Question: One of our providers has been treating an established patient for trigeminal n... Read more
Reader Questions:
Use Modifier 52 for Interrupted Polysomnography
Question: A patient visited our clinic to undergo polysomnography. She was hooked up to ... Read more
Reader Questions:
ABN Supersedes NEMB Form Soon
Question: I have heard that the new advance beneficiary notice makes the notice of exclu... Read more
Reader Questions:
Confirm Neuro Exam Functions for Reimbursement
Question: We have a new neurologist in our department. In her examination documentation ... Read more
Reader Questions:
Check With Carrier for Bilateral Injection
Question: Our neurologist injected botulinum toxin for blepharospasm into a patient's lo... Read more
You Be the Coder:
Should CTS Be the Primary Dx?
Question: Our neurologist has been treating a patient with pain in his fingers that trav... Read more
Prepare Now, and Proposed ICD-9 Headache Codes Will Be No Pain, All Gain
You may have to leave your 784.0 comfort zone in 2009 ICD-9 2009 may include more new c... Read more
Keep Up With Somatic Nerve Injection Changes This Spring
Let our experts show how these switches can mean more green for you A recent CMS update... Read more
Watch for Changes on the Prolonged Services Horizon
Learn what CMS has in store for you -- and how it will affect E/M coding Coding for pro... Read more
Reader Questions:
Full Dx Necessary in Diabetic Neuropathy Coding
Question: I-m a new neurology coder trying to code for one of our patients who has diabe... Read more
Reader Questions:
Code Carefully With 90766 to Avoid Denials
Question: We have quite a few 90766 denials stating that the "qualifying service was not... Read more
Reader Questions:
Options in Coding for Possible Feigned Illness
Question: We recently had a patient complaining that she had migraine pain. When our neu... Read more
You Be the Coder:
Determining Patient Status
Question: Our neurologist saw a patient for muscle and range-of-motion testing on her ri... Read more
Combat Common EEG Coding Pitfalls -- And Get Your Claims Paid
Get the scoop on using 95953 for tests under 24 hours The key insights into electroence... Read more
Learn AAN, ACNS 24-Hour Rule
Example 1: A patient experienced cerebral seizures and underwent testing lasting for 14 ... Read more
Use CMS Site to Your EEG Advantage
McCormack offers several other useful suggestions to coders reporting EEG testing situatio... Read more
End Your Extended Monitoring Coding Confusion
Let us show you when the time is right to code for EEG procedures One of the main sourc... Read more
Know Which Nerve Conduction Study Code Is Right for You
Take the fear out of modifier 59 using the scenarios our experts reveal Choosing the ap... Read more
Cruise to the Bank With NCS Reimbursement
Exceed carrier limits the legitimate way When you-re coding for nerve conduction studie... Read more
Reader Questions:
Follow Insurer When Nerve Monitoring Billing
Question: Can I bill for facial nerve monitoring for 100 minutes in a hospital setting w... Read more
Reader Questions:
Choose 723.8 for Occipital Neuralgia
Question: Can I code specifically for an occipital headache, or do I have to code for ju... Read more
Reader Questions:
Be Careful When Reporting Second Opinions
Question: If one of our neurologists offers a second opinion, how should I report the se... Read more
Reader Questions:
Use 95903 for Same-Nerve Conduction Studies
Question: When I-m coding for nerve conduction studies, do payers consider amplitude and... Read more
You Be the Coder:
Make the Right Choice When AIN Coding
Question: A neurologist entered an "anterior interosseous syndrome or focal nerve entrap... Read more
Take Luck Out of the Botox Equation With These Surefire Strategies
Don't roll the dice with 64612 reimbursement You face a lot of bumps on the road to get... Read more
3 Bonus Tips Guarantee Botox Reimbursement
Tackle billing snafus with a team effort Now that you-ve taken care of everything invol... Read more
Boost Your Diabetic Neuropathy ICD-9 Accuracy in 3 Easy Steps
Read this before polyneuropathy coding The next time you face a joint injection or nerv... Read more
Speed Up Diabetic Neuropathy CPT Choices With This Rundown
Separate diagnostic, therapeutic and prognostic services for clean claims In treating d... Read more
Bone Up on Your ROS-Level Knowledge
Question: What are the various review of system (ROS) levels? Kentucky Subscriber An... Read more
Reader Questions:
'Inching' Coding Offers Multiple Billing Opps
Question: Is there a separate code for "inching" nerve conduction studies? Vermont Subs... Read more
Reader Questions:
Know Method, History for t-PA Administration
Question: What are the appropriate codes for administering t-PA to the spine (intrathecal)... Read more
Reader Questions:
Check With Carrier for Multiple EMG Coverage
Question: I reported 64613, 64614 and J0585 (Botulinum toxin type A, per unit) for a che... Read more
You Be the Coder:
Clarify Cervical Injection Coding
Question: When my neurologist injects the lower cervical muscles with bupivacaine, which... Read more
Watch Out:
Latest CCI Edits Take Aim at 96125
Experts reveal which 14.0 edits will have the most effect Correct Coding Initiative (CC... Read more
Here's Your Handy Guide to the New CCI 14.0 Edits
Save this useful list to help troubleshoot when you-re dealing with these changes ... Read more
Learn the Legit Way to Override CCI Edits
Get reimbursement for bundled codes in 3 simple steps You can override Correct Coding I... Read more
Try This 5th-Digit Tip to Save Your Claims
Don't risk denied claims -- or worse You know that your diagnosis coding needs to suppo... Read more
Reader Questions:
Mind Your Acupuncture Claims Submissions
Question: We-re considering offering acupuncture services. We don't know whether carrier... Read more
Reader Questions:
Review Office's Records Retention Policy
Question: How long should I keep patient files before destroying them? I have heard answ... Read more
Reader Questions:
Bill for Both Catheter and Pump Removal
Question: One of our physicians removed a morphine pump and intrathecal catheter and ent... Read more
Reader Questions:
OK to Bill Multiple EMG With Chemodenervation
Question: Can we bill multiple units for the EMG guidance with chemodenervation (95874)?... Read more
Reader Questions:
Try V12.4 for Seizures After the Fact
Question: Which diagnosis code should I use for a resolved seizure? Virginia Subscriber... Read more
Reader Questions:
Use Surgery Diagnosis for IOM
Question: When our neurologist monitored a patient's nerves during surgery, the electrom... Read more
Reader Questions:
Appeal Multiple-NCS Claim Denials
Question: We conduct multiple sensory and/or motor nerve conduction studies for patients... Read more
Reader Questions:
Nerve Disorder Code Is Best Bet for Neck-Tongue Syndrome
Question: Which ICD-9 code should I report for neck-tongue syndrome? Georgia Subscriber... Read more
You Be the Coder:
Cervical Facet Arthritis Gets Specific Diagnosis
Question: What ICD-9 code should I report for cervical facet arthritis?   &nb... Read more
Procedure Focus:
Follow These Tips to Boost Your Interrupted Lumbar Puncture Accuracy
Modifier 53 and documentation help clarify coding A Neurology Coding Alert reader recen... Read more
Compliance Corner:
Track Locum Tenens Billing Accurately or Face Audits
Use computerization, special file for temp doctor A locum tenens physician may be a tem... Read more
Unit Know-How:
Get the Straight Answers on ENG and VNG Allowable Units
Reporting 92546 for standard ENG testing? AMA says not so fast If you-re confused about... Read more
Reader Questions:
Choose Modifier Carefully for Dual Injections
Question: Our physician recently treated a patient in our office with olecranon bursitis... Read more
Reader Questions:
Search 438.xx for CVA Late Effects
Question: What diagnosis should I report for post-CVA deficits? Michigan Subscriber ... Read more
Reader Questions:
Let MD Narrow Diagnosis for Alexander Disease
Question: What is the correct diagnosis for Alexander disease? Kentucky Subscriber A... Read more
Reader Questions:
Look to 310 and 331 for Mild Cognitive Impairment
Question: What diagnoses do carriers usually accept for mild cognitive impairment? Tenn... Read more
Reader Questions:
Inching Along Doesn't Merit Separate Code
Question: Does CPT include a separate code for "inching" nerve conduction studies? Cali... Read more
Reader Questions:
Intraoperative EMG Calls for Surgery Diagnosis
Question: The neurologist monitors a patient's nerves while she is in the operating room... Read more
Reader Questions:
96415 Doesn't Count Toward Observation
Question: Our physician administered a one-hour infusion of Tysabri, followed by one hou... Read more
Reader Questions:
Documentation Guides Occipital Headache Code
Question: What diagnosis applies to an occipital headache? Should I code for just a regu... Read more
You Be the Coder:
Injections With Electromyographies
Question: Our neurologist performed a unilateral needle electromyography on three extrem... Read more
CPT Makeover:
Learn How the 2008 Modifier Changes Will Affect Your Claims
Don't miss what an updated modifier 25 has in store for PAs and CRNPs CPT 2008 include... Read more
Coding 101:
59 Made Easy: Look for a Separate Location/Session
Be sure to check CCI for a -1- modifier indicator Properly applying modifier 59 is esse... Read more
Audit Heads-Up:
Brace Yourself for RACs -- and What Their Visits Might Mean
Look for more intense scrutiny of Medicare payments in 2008 Billing Medicare as the pri... Read more
Reader Questions:
Code Headache Separately From West Nile Fever
Question: What diagnoses apply to West Nile virus with encephalitis and post-encephaliti... Read more
Reader Questions:
Verify That ADHD Claim Goes to Correct Payer
Question: Our payer is denying any claims our pediatric neurologists submit for patients... Read more
Reader Questions:
Remember Fifth Digit for Myasthenia Gravis Dx
Question: One of our technicians is training to perform repetitive nerve stimulation on ... Read more
Reader Question:
Flat Fee Might Be Best for Visit Without Patient
Question: Does CPT include a code we can use when the physician sees the patient's famil... Read more
Reader Questions:
Report 95806 for Off-Site Sleep Test Monitoring
Question: Our staff completed a portable sleep study in the patient's home (staged, with... Read more
Reader Questions:
Append 26 to Report Separate EEG Reading
Question: Our technologist often administers the EEG, and the physician reads the result... Read more
Reader Questions:
Look to 354.1 for Anterior Interosseous Syndrome
Question: Our physician noted "anterior interosseous syndrome or focal nerve entrapment"... Read more
Reader Questions:
Erase PHI Before You Click 'Send'
Question: I sometimes e-mail patient records to consultants or other coders for help on ... Read more
Reader Questions:
Nerve Monitoring May Be Bell's Palsy Check
Question: I overheard a coworker discussing facial nerve monitoring testing for patients... Read more
Reader Questions:
Finally, You Can Look Up NPI Information
Question: Is the NPI database up yet? I can't figure out where to look for it. Wyoming ... Read more
You Be the Coder:
Documenting a Nonresponsive Patient
Question: One of our patients is nonresponsive and unable to answer questions. The neuro... Read more
CPT Update:
2008 Adds to Cognitive Testing Options and Revises One of Your Most-Used Codes
Check out these changes to testing -- and watch your telephone consults Don't be fooled... Read more
Coding 101:
Conquer Add-On Codes With This Easy Checklist
Always appeal -multiple-procedure reductions- with add-ons Reporting "add-on" codes is ... Read more
Clip and Save:
Here's the Quick Way to Find Out if the Patient Is Really New
Ask yourself 5 easy questions to pinpoint the answer If your coders have trouble distin... Read more
Reader Questions:
Correctly Reporting Tensilon Medication Code
Question: Should I report a J code for Tensilon in addition to code 95857? Illinois Sub... Read more
Reader Questions:
'Unlisted' 92499 Best Bet for Pupillometry
Question: How should I code for pupillometry? Oregon Subscriber Answer: CPT does no... Read more
Reader Questions:
Treatment, Tests Don't Rule Out a Consult
Question: Can I still report a consultation if the consulting physician initiates treatm... Read more
Reader Questions:
Documentation Drives Multi-Puncture Coding
Question: How should I bill for a lumbar puncture that was both diagnostic and therapeut... Read more
Reader Questions:
Splitting Service Between Neurologist and ENT
Question: Our neurologist worked with an ENT to perform an EMG of the larynx. The ENT pl... Read more
Reader Question:
Look to 310 and 331 for Mild Cognitive Impairment
Question: What diagnoses do carriers usually accept for mild cognitive impairment? Ten... Read more
Reader Questions:
Most Payers Balk at Bilateral 64614
Question: One of our payers refuses to reimburse 64614 bilaterally. The payer says that ... Read more
Reader Questions:
Patients Who Follow MD Could Be New ... or Not
Question: A new physician has just joined our group, and some of his patients will now s... Read more
You Be the Coder:
19-Hour EEG
Question: Our neurologist performed a 19-hour continuous EEG study on a patient in the h... Read more
Red Flag:
Urinary or Sepsis Problems Can Lead to Neurological Coding Complications
Code neurological conditions based on diagnosis, not symptoms You might be an ace at co... Read more
Procedure Basics:
You Can Report 96118, 96119 Separately -- if Details Fit
Watch these 2 areas to keep your claims legit If correctly reporting CPT 96118 and CPT... Read more
Compliance:
PHI Release Authorizations Aren't Always Forever
Make sure your authorization to disclose PHI hasn't expired One year ago, your patient ... Read more
Reader Questions:
Watch Documentation for tPA and Critical Care
Question: What is the appropriate way to bill for tPA? Can we bill for tPA on the same d... Read more
Reader Question:
Consult Criteria May Differ by Payer
Question: I-ve seen information containing consultation definitions that differ from CPT... Read more
Reader Question:
95920 Can't Coincide With Office Visit
Question: One of our physicians says he can concurrently monitor intraoperative neurophy... Read more
Reader Question:
Reason for Fall Helps Guide Diagnosis
Question: What diagnosis should I report for a patient who falls frequently? New Jerse... Read more
Reader Question:
Check That Diagnoses You Submit Are in ICD-9
Question: Our Blue Cross carrier denied our claim with diagnoses 847.0, 307.87 and 346.0... Read more
Reader Question:
Understanding Transitional Facility vs. Nonfacility
Question: What is the difference between a transitional nonfacility and a transitional f... Read more
Reader Question:
Verify Details Before Using 95812
Question: Should we report 95812 or 95816 for an EEG obtained in the awake state only? ... Read more
Reader Question:
Observe PHI Rules for Patients and Staff
Question: How should a medical facility handle employees- access to their own medical re... Read more
You Be the Coder:
Multiple-Level EMGs
Question: Should we bill modifier 59 when our neurologist performs multiple levels of EM... Read more
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