Neurology & Pain Management Coding Alert

Tip: Many edits allow you to break the bundle, so watch modifier indicators.

Check out the latest National Correct Coding Initiative (CCI) edits, especially if you code for canalith repositioning procedures (CRP) or plantar digital nerve injections. CCI version 17.1 went into effect April 1, 2011, and includes numerous edit pairs for both procedures.

Expect Canalith Pay -- Alone

CPT 2009 first introduced 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day). Coders applauded the addition, but the 2009 Medicare Physician Fee Schedule cut celebrations short. CMS assigned the code 'B' status, meaning payment for the CRP or Epley maneuver was bundled with other procedures. The 2011 Medicare Physician Fee Schedule changed that, when code 95992 switched to "A" status. "We finalized the proposal with a work RVU of 0.75 and the RUC recommended PE inputs," says Marc Hartstein, deputy director for the Hospital and Ambulatory Policy Group for the Center for Medicare.

Edit watch: Now that you can be separately paid for 95992, check whether CCI edits allow you to report canalith repositioning in conjunction with other procedures. CCI 17.1 classifies 95992 as the comprehensive procedure when performed during the same session as several other services, meaning you shouldn't bill for both. The component procedures paired with 95992 include:

• 92531 -- Spontaneous nystagmus, including gaze
• 92532 -- Positional nystagmus test
• 97110 -- Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
• 97112 -- ... neuromuscular reeducation of movement,balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
• 97140 -- Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes
• 97530 -- Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.

The code pairs involving 92531 and 92532 have a modifier indicator of "0," which means you cannot bypass the bundling edits 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 code.

Good news: The remaining edit pairs carry a modifier indicator of indicator of "1," meaning there is the potential to be able to bypass the bundling 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).

Plantar Injection Overrides Other Services

More than 60 edits in CCI 17.1 apply to codes 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]) and 64632 (Destruction by neurolytic agent; plantar common digital nerve).

Edits list the plantar nerve injection or destruction as the comprehensive procedure in the pairs. Check CCI 17.1 for a complete listing, but here are a few codes to watch for:

• Code 64455 is the comprehensive component when performed with procedures such as 36425 (Venipuncture, cutdown; age 1 or over), 36600 (Arterial puncture, withdrawal of blood for diagnosis), 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), or 94690 (Oxygen uptake, expired gas analysis; rest, indirect [separate procedure]), and others.
• Code 64632 is the comprehensive procedure when the destruction is performed during the same session as 93000, 94680 (Oxygen uptake, expired gas analysis; rest and exercise, direct, simple), 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes), and more.

All of the edits affecting 64455 and 64632 have a modifier indicator of "1." Again, double check your physician's documentation for enough supporting information before reporting both codes together.