Neurology & Pain Management Coding Alert

Plus: Consultations and transitional care management also take the back seat.

New Correct Coding Initiative (CCI) edits went into effect on Jan. 1, 2014, with neurology and pain management each adding thousands of edit pairs to common procedure codes. The numbers are daunting on the surface – until you dig a bit and realize the majority affecting neurology and pain management focus on only a few areas of care.

Note: All neurology and pain management edits in CCI 20.0 are classified as non-mutually exclusive, meaning you should not report both services in an edit pair on the same claim for work during the same patient encounter. They’re also known as comprehensive/component edits because one service inherently includes the other.

Assume New Chemodenervation Codes Override Others

Learning to report new chemodenervation codes is one of your biggest changes for 2014. It should come as no surprise, then, to learn that CCI 20.0 introduces thousands of edits incorporating the new codes:

• 64616 – Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis)
• 64617 – … larynx, unilateral, percutaneous (e.g., for spasmodic dysphonia), includes guidance by needle electromyography, when performed
• 64642 – Chemodenervation of one extremity; 1-4 muscle(s)
• +64643 – … each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
• 64644 – … 5 or more muscle(s)
• +64645 – … each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure)
• 64646 – Chemodenervation of trunk muscle(s); 1-5 muscle(s)
• 64647 – … 6 or more muscle(s).

Best tactic: The applicable edits are so extensive that your best first step when coding these procedures is to assume that the chemodenervation should be reported instead of any other procedure your provider performs during the same encounter. Always check the edits to verify the situation, however, before submitting your claim.

Take Care With Consultative Services and TCM

Thousands of additional edits apply to time spent on telephone or internet assessments and consultations:

• 99446 – Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the`patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
• 99447 – … 11-20 minutes of medical consultative discussion and review
• 99448 – … 21-30 minutes of medical consultative discussion and review
• 99449 – … 31 minutes or more of medical consultative discussion and review.

These codes are new for 2014 and are intended to be used when your physician provides a consult by telephone or internet to another requesting provider. CCI specifies that the consults are inherent to many services you might code for, ranging from pain management injections 20526 (Injection, therapeutic [e.g., local anesthetic, corticosteroid], carpal tunnel) or 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level) to neurology procedures 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas), 95929 (Central motor evoked potential study [transcranial motor stimulation]; lower limbs), and more.

You began reporting transitional care management (TCM) codes in 2013, but had to work your way around numerous coding edits introduced throughout the year. The same holds true for TCM codes this year:

• 99495 – Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; Medical decision making of at least moderate complexity during the service period; Face-to-face visit, within 14 calendar days of discharge
  
• 99496 – … within 7 calendar days of discharge.
  

These codes are bundled into multiple procedures just as the consultative services codes listed above.

A few specific examples of procedures you would report instead of the column 2 TCM services include 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic), 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch), and 64611 (Chemodenervation of parotid and submandibular salivary glands, bilateral).

Bottom line: Don’t automatically include one of the TCM or phone/internet consultation codes to a claim just because your physician provided the service and has supporting documentation. Chances are, CCI considers the service part of the wider-scope procedure your physician performed.

Check for the Modifier Silver Lining

CCI sometimes pairs two services as non-mutually exclusive (or comprehensive/component), but still allows you to report both services for an encounter – under certain circumstances. Most neurology and pain management edits in CCI 20.0 can’t be unbundled, but always verify the pair’s modifier indicator to know whether separate reporting is possible.

Example 1: The edit bundling 99446 into 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas) carries a modifier indicator of “0,” so you cannot append a modifier to break the edit and report both services.

Example 2: The edit bundling 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) into 64647 carries a modifier indicator of “1.” You might be able to report both services from the same patient encounter together, if the services were for different encounters or different sites and your physician’s documentation demonstrates this. If so, you would append a modifier such as 59 (Distinct procedural service) to the column 2 bundled code. In this case, the modifier would be reported with 96372.

Resource: Check the complete CCI file on the CMS website to see which edits will apply to your practice. Log onto www.cms.gov and search for “CCI 20.0”. Edits under CCI 20.0 are effective from Jan. 1, 2014 until March 31, 2014.