Neurology & Pain Management Coding Alert

Don't let neurostimulator procedures with anesthetics trip your coding.

Get ready for some changes to your EP, EMG, and sleep study coding, thanks to the latest Correct Coding Initiative (CCI) edits. CCI 18.0 became effective Jan. 1, 2012, including details on how to report new EP study codes 95938 and 95939 in conjunction with other services. Read on for details, thanks to a guideline analysis from Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding.

Anesthetics Override EP Studies, Neurostim Placement

If your neurologist administers nerve injections as well as evoked potential studies on the same patient on the same date of service, CCI 18.0 clarifies that you should report the nerve injection only and not separately report the EP study.

New edits list every code for nerve injections (64400-+64495) as the Column 1 code for new codes 95938 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs) and 95939 (Central motor evoked potential study [transcranial motor stimulation]; in upper and lower limbs).

Reminder: When CCI edits pair two codes together, you typically report the Column 1 code instead of the Column 2 code. The Column 1 code either represents a comprehensive procedure that includes the services of the Column 2 code as a component of the comprehensive, or represents a procedure that "outweighs" the Column 2 code and should be reported alone.

In the case of the nerve injections with codes 95938 and 95939, you should report the CPT® code(s) for the nerve injection(s) (the Column 1 code) instead of the EP study.

CCI also pairs some of the nerve injection procedures, 64450 -- 64495, with four Category III codes:

• 0282T -- Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial. Including removal at the conclusion of trial period
• 0283T -- Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; permanent, with implantation of a pulse generator›› ››
•  Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed
• 0285T -- Electronic analysis of implanted peripheral subcutaneous field stimulation pulse generator, with reprogramming when performed.

Explanation: Chapter 11 of the NCCI manual states, "If nerve testing (e.g., EMG, nerve conduction velocity) is performed to assess the level of paralysis during anesthesia or during mechanical ventilation, the range of CPT® codes 95851-95937 are not separately reportable. These codes describe significant, separately identifiable diagnostic services requiring a formal report in the medical record. Electrical stimulation used to identify or locate nerves during a procedure involving treatment of a cranial or peripheral nerve (e.g., nerve block, nerve destruction, neuroplasty, transaction, excision, repair) is integral to the procedure and is not separately reportable."

Again, all of these new CCI bundling edits carry a "0" modifier indicator, which means you can only report the nerve injection instead of the Category III code when performed by the same provider on the same patient on the same date of service.

Editor's note: Follow up the next issue for more on CCI edits for sleep studies and EMGs.