Neurology & Pain Management Coding Alert

Version 7.2 of the national Correct Coding Edits (CCI), which became effective July 1, contains many edits that affect codes and code combinations used by neurology practices.

 
Two spinal puncture codes bundle spinal injection codes, so the procedures may no longer be separately billed if performed at the same anatomical site:   
 

Code 62270 (spinal puncture, lumbar, diagnostic) includes 62311 (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; lumbar, sacral [caudal]) and 64483 (injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level).
 

Code 62272 (spinal puncture, therapeutic, for drainage of spinal fluid [by needle or other catheter]) also includes 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), 62311, 64479 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level) and 64483.

 
The following injection code has edits:

62273 (injection, epidural, of blood or clot patch) bundles seven additional codes: 62284 (injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]), 62310, 62311, injection and catheter placement for continuous infusion or intermittent bolus codes 62318 (... cervical or thoracic) and 62319 (... lumbar, sacral [caudal]), 64479 and 64483. 

 
Each of the above edits includes a CCI edit indicator of "1," meaning modifier -59 (distinct procedural service) may be used to break the bundle if the "comprehensive" procedure (i.e., 62270, 62272 or 62273) and the "component" procedure (i.e., 62311) are performed at different anatomical sites.
 
Always append the appropriate modifier to the component code. For example, the neurologist performs a lumbar spinal puncture and injects an anesthetic agent at a different lumbar level. In this case, 62270 and 64483 may be reported separately, with modifier -59 appended to the latter. Documentation should clearly note that the puncture and injection occurred at distinct lumbar levels, e.g., at the L1-L2 and L2-L3 interspaces.

 
Biofeedback training (90901, ... by any modality) bundles five new procedures: EMG studies 51784 (... of anal or urethral sphincter, other than needle, any technique) and 51785 (... of anal or urethral sphincter, any technique), as well as 51795 (voiding pressure studies [VP]; bladder voiding pressure, any technique), 64550 (application of surface [transcutaneous] neurostimulator) and 91122 (anorectal manometry). 

 
Several codes have been newly designated as components of "more extensive" procedures.
 
As mentioned, EMG studies 51784 and 51785 are now included in 90901. Code 62270 is a newly designated component of neonatal intensive care codes 99295-99298.
 
Other code changes are less likely to affect neurologists. For instance, IV infusion codes are now included in a host of procedures: 90781 (IV infusion for therapy/ diagnosis, administered by physician or under direct supervision of physician; each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) is bundled to therapeutic apheresis and photopheresis codes 36520, 36521 and 36522, as well as HCPCS code G0154 (services of skilled nurse in home health setting, each 15 minutes).
 
Code 90780 (... up to one hour) is bundled to all of the above, plus 67221 (photodynamic therapy), medicine code 90378 (respiratory syncytial virus immune globulin) and G0184 (destruction of localized lesion of choroid).    

Injection codes 90782-90788 have likewise been included in many new codes, but these edits generally will not apply to procedures undertaken by neurologists. 
 
Note: Always consult the CCI for a complete list of bundled codes. The edits are available by subscription from the National Technical Information Service (NTIS) in print or as a CD-ROM in searchable (.pdf) format. The CD includes the software needed to read the file. Contact NTIS for more information, 1-800-363-2068 or www.ntis.gov/products/hcfa.htm. Also, for how to interpret these changes, please see the article on our Web site: http://codinginstitute.com/docs, Document "25."
 
Watch for Suspect Edits

 
Although CCI has become a powerful tool for physicians and payers that want to ensure correct coding, the edits are not infallible. Most quarterly updates of the CCI (although not 7.2) include dozens of edit deletions to correct inappropriate code combinations. Physicians and coders should watch for erroneous edits and work with specialty associations and CMS to eliminate them, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine.
 
For instance, 95860 (needle electromyography, one extremity with or without related paraspinal areas) bundles 95869 (needle electromyography; thoracic paraspinal muscles) and 95870 (... limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) but is itself a component of several codes, including 95808, 95810, 95861, 95875, 95963, 95964 and others. However, Busis says, 95860 is for limbs only, while 95869 is for thoracic paraspinal muscles unrelated to limbs and is not covered by 95860, regardless of which limb is studied. Modifier -59 may be attached to differentiate the services, but this should not be necessary because the codes are, by definition, distinct procedures performed in separate areas.
 
Codes 95808 and 95810, meanwhile, are sleep studies. "The EMG electrodes used in them have nothing whatsoever to do with a 'real' EMG," Busis argues, and therefore 95860 should not be bundled to 95808 and 95810.