Neurology & Pain Management Coding Alert

Double check before separately reporting paravertebral facet injections.

The latest Correct Coding Initiative (CCI) edits went into effect July 1, 2010, and have several "switched edit" pairs of neurology codes you should check. If your neurologist performs pain management injections, you'll also want to incorporate changes for some medications and procedures.

CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. Here's what you need to know about edits that might affect your coding.

Change Columns for +95920 and Others

When CCI pairs codes as "mutually exclusive procedures," you can't report those two procedures during the same patient encounter. Always submit the "Column 1" code of the pair, as submitting the "Column 2" choice can lead to denials.

New versions of CCI sometimes include a few edits that reverse the Column 1 and Column 2 codes. Four current neurology code pairs in CCI 16.2 fall into this group, so update your software or coding notes accordingly:

Whether you can submit both codes for the encounter depends on whether CCI assigns a "0" or "1" modifier indicator to the pair.

"0" modifier indicator means you should never report both codes together. "1" modifier indicator means you can report both codes under certain circumstances and with enough supporting documentation. You'll append one of the CCI-associated modifiers such as modifier 59 (Distinct procedural service) to the Column 2 code, thus unbundling the edit and allowing payment for both services.

EEG, Pump Refills Appear in NME Edits

Column 1/Column 2 edits, also referred to as non-mutually exclusive edits (NMEs), include pairs of procedures your physician could reasonably perform during the same session. Whether you report both procedures, however, depends on the modifier indicator for the pair.

EEG recording: Non-mutually exclusive edits in CCI 16.2 pair 95830 (Insertion by physician of sphenoidal electrodes for electroencephalographic [EEG] recording) with HCPCS codes J0670 (Injection, mepivacaine HCL, per 10 ml) and J2001 (Injection, lidocaine HCL for intravenous infusion, 10 mg). The pairs carry a "1" modifier indicator, so you can break the edit by appending modifier 59 to the J code when appropriate. Otherwise, simply report 95830.

Kit included: Two other edits bundle A4220 (Refill kit for implantable infusion pump) into procedures 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]) and 95991 (... administered by physician). Both bundling edits carry a modifier indicator of "0," so payers who also use CCI edits to process provider claims will deny any claims with both codes reported on the same beneficiary on the same date of service by the same provider.

Steer Clear of Separate Mepivacaine HCL Your provider might rely on Mepivacaine HCL (Carbocaine), a local anesthetic similar to Lidocaine, for nerve, soft tissue and/or joint injections, but you can no longer separately report the medication for some procedures. CCI edits now bundle J0670 (Injection, mepivacaine HCL, per 10 ml) with many common injections such as:

• 20526 -- Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel
• 20550 -- Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
• 20552 -- Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
• 20600 -- Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)
• 64405 -- Injection, anesthetic agent; greater occipital nerve
• 64450 -- Injection, anesthetic agent; other peripheral nerve or branch
• 64493 -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level.

Flip side: CCI 16.2 classifies the J0670 edits with a modifier indicator of "1." When justified, you can report both codes and append modifier 59 (Distinct procedural service) to unbundle the pair.

Other Work Includes Paravertebral Facet Injection  Although the current CPT book doesn't include them, you could begin using several new codes for paravertebral facet joint injections in January 2010. Now CCI edits bundle two of the new codes with chemodenervation injections and many nerve destruction procedures. The paravertebral injection codes affected are:

• 0213T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• 0216T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.

Procedures paired with 0213T and 0216T range from 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) to 64650 (Chemodenervation of eccrine glands; both axillae).

Most of the edit pairs carry a "0" modifier indicator, but CCI lists a few with modifier indicator "1." Check the full CCI file to verify whether you can use a modifier to break specific edits.

Mutually Exclusive Edits Also Hit 0213T-0218T

Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive edits, as well. CCI 16.2 pairs each of the new category III codes using ultrasound for guidance with the corresponding paravertebral facet joint injection codes using fluoroscopy or CT guidance:

64490-64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic ...) and 64493-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral ...).

Each edit carries a "0" modifier indicator, so you can't use modifier 59 to override the bundling.

CCI 16.2 includes more than 16,800 edits. Check the latest version at www.cms.gov  to ensure you correctly report procedures.