Neurology & Pain Management Coding Alert

Plus: Add TPIs, arthrocentesis, and more to the 'no with fluoro' camp.

One look at the newest Correct Coding Initiative edits clarifies that you shouldn't typically report the new wheeze measurement Category III codes with sleep studies or fluoroscopic guidance with many common injection procedures. CCI 17.0 went into effect Jan. 1, 2011, so read on for some important updates.

Check Out 0243T, 0244T Edits with Sleep Studies

Non-mutually exclusive edits apply to services that a physician might perform during the same care session but that aren't billable together. This is because one of the codes (the Column 2 or component code) is included in the services represented by the Column 1 (comprehensive) code of the pairing. You can bill individual components if the physician does not perform the entire comprehensive procedure. But if the physician performs the entire (comprehensive) procedure, you should bill the comprehensive code instead of the individual parts or components.

The American Medical Association introduced two new wheeze rate measurement codes in July 2010, with implementation beginning Jan. 1, 2011:

• 0243T -- Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge diagnostic evaluation(s), with interpretation and report
• 0244T -- Continuous measurement of wheeze rate during treatment assessment or during sleep for documentation of nocturnal wheeze and cough for diagnostic evaluation 3 to 24 hours, with interpretation and report.

According to CCI 17.0, 0243T and 0244T combine with sleep study and other codes to make non-mutually exclusive edit pairs. Do not report 0243T or 0244T in conjunction with the following sleep study codes unless special circumstances apply:

• 95806 -- Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effect (e.g., thoracoabdominal movement)
• 95807 -- Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
• 95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
• 95810 -- ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist
• 95811 -- ... sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevelventilation, attended by a technologist.

Exceptions: Each edit pair carries a modifier indicator of "1," meaning you can sometimes bypass the edit by filing your claim with an appropriate modifier. Be sure you have enough supporting documentation to justify payment for both codes before filing with a modifier such as 59 (Distinct procedural service). For example, documentation could include notes that indicate the provider performed the wheeze rate measurement during a different session from the comprehensive sleep study but still on the same day.

Nix Fluoroscopic Guidance for Common Procedures

CCI 17.0 also establishes non-mutually exclusive edits for several common procedures neurologists and pain management specialists provide when those procedures are performed with fluoroscopic guidance. The guidance procedures being singled out include:

• +77001 -- Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)
• 77002 -- Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device).

According to CCI 17.0, you shouldn't report +77001 or 77002 when your physician administers trigger point injections (20552 or 20553) or administers tendon sheath injections (20550-20551). CCI 17.0 also includes edits stating you shouldn't report +77001 with most diagnostic or therapeutic nerve injections (64400-64530) or most nerve destructions (64600-64681). Instead, just report the primary procedure itself. The edit might not affect your coding since neurologists would rarely perform the service represented by +77001 with nerve injection or destruction. You should always keep abreast of new edits, however, just in case they surface in your provider's practice.

Again, each edit pair carries a modifier indicator of "1." Watch your provider's documentation for times when you can justify reporting both services from the edit pair during the same encounter.

New Chemodenervation Code Overrides Other Injections

More than 100 non-mutually exclusive pairs include new code 64611 (Chemodenervation of parotid and submandibular salivary glands, bilateral). CCI 17.0 classifies 64611 as the comprehensive procedure when performed during encounters such as:

• 36000 -- Introduction of needle or intracatheter, vein
• 62310 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
• 64400-64450 -- Injection, anesthetic agent ...
• 95860-95870 -- Needle electromyography ...
• 95900-95904 -- Nerve conduction, amplitude and latency/velocity study, each nerve ...
• 95905 -- Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report.

Indicator: The majority of edits involving 64611 carry a modifier indicator of "0," which means you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you'll receive an automatic denial for the Column 2 componentcode. Some edit pairs, however, carry a modifier indicator of "1." Check the CCI data carefully before submitting another code with 64611 to ensure you're within the guidelines.

Forget Subsequent Care With Developmental Testing

You have three new codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the evaluation and management of a patient ...) in CPT 2011. Before reporting the service, however, watch for associated edits.

CCI 17.0 notes that extended developmental testing represented by 96111 (Developmental testing; extended [includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments] with interpretation and report) include services represented by 99224-99226. The edits do carry a modifier indicator of "1," however, so you can unbundle the pairs and report both codes in some situations.

FYI: CCI 17.0 includes 698,042 active edit pairs, according to an analysis by Frank Cohen, MPA, MBB, senior analyst for The Frank Cohen Group in Clearwater, Fla. Check the latest version at http://www.cms.gov/NationalCorrectCodInitEd/ to ensure you correctly report procedures.