Neurology & Pain Management Coding Alert

Hint: Visit 'deleted edits' section for updates to paravertebral facet joint injections.

The latest edition of Correct Coding Initiative (CCI) edits, effective Oct. 1, holds some nice surprises for neurology and pain management coders. Instead of being saddled with additional edits that restrict your claims filing, most pairs related to neurology or pain management actually fall under the "deleted edits" category.

"For the terminated pairs, 218 were retroactively terminated back to the last quarter release and one back to January 1, 2010," says Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC, in Clearwater, Fl. "This means that, if you were denied payment due to these edit pairs in the past, you would likely be able to resubmit the claim for payment at this time."

Check Deletions for Injection/ Vascular Procedure Bundles

Terminated bundles affect three groups of procedures performed by neurologists or pain management specialists: therapeutic or diagnostic injections, paravertebral facet joint injections (with either image or ultrasound guidance), and somatic nerve injections.

The affected diagnostic or therapeutic injection codes include:

• 96372 -- Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
• 96374 -- Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
• 96375 -- Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

Two Category III codes also fall into the "deleted pairs" group:

• 0213T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• 0216T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.

Additionally, previous edits bundled the majority of somatic nerve injections 64400-+64484 (Injection, anesthetic agent ...) and paravertebral facet joint injections 64490-+64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] ...) into a wide range of intra-arterial and venous procedures. CCI now deletes those bundles, as well.

Example: Earlier editions of CCI listed the listed injections as components of vascular procedures such as 36000 (Introduction of needle or intracatheter, vein), 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]), and 36425 (Venipuncture, cutdown; age 1 or over). Double check your claims after Oct. 1 to verify whether some of the previous bundles might now be allowed, and if you can refile claims because of retroactive changes.

CCI version 17.3 offers 1,380 new edit pairs and 835 terminated bundles, according to Cohen's analysis. Visit the CMS web page at www.cms.gov/NationalCorrectCodInitEd for the full CCI report.