Neurology & Pain Management Coding Alert

Version 8.1 of the national Correct Coding Initiative (CCI) is now available. The latest quarterly update, which remains active from April 1 to June 30, 2002, contains no significant edit additions or deletions but does include several minor changes that will affect coding in neurology practices.

CCI classifies coding edits into two categories: mutually exclusive code pairs and comprehensive/ component code pairs, explains Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. Mutually exclusive procedures are those services/procedures "that cannot reasonably be done in the same session. An example of a mutually exclusive situation is when the repair of the organ can be performed by two different methods. One repair method must be chosen to repair the organ and must be reported," according to CCI. Such edits are arranged into column 1 and column 2 codes. Per CCI instructions, mutually exclusive codes are not bundled (procedures identified with column 1 codes are not included in or incidental to procedures identified with column 2 codes, or vice versa). However, they are not to be billed together due to conflicting CPT definitions for the two codes or the "medical impossibility/improbability that the procedures could be performed at the same session." When codes identified as mutually exclusive are reported for the same patient encounter, generally only the lesser-valued (column 1) procedure will be recognized and reimbursed.

Version 8.1 contains no additions or deletions to the mutually exclusive code category that will affect neurology coding.

Comprehensive/component code pairs are the more familiar bundling edits in which one procedure/service (identified as the component code) is considered a standard part of or incidental to a more complex or definitive procedure/service (identified as a comprehensive code) and, therefore, may not be reported or reimbursed separately. A common example in neurology practices is the bundling of 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study)to 95903 ( motor, with F-wave study). Because nerve conduction studies (NCS) without F-wave are an integral and included part of NCS with F-wave, billing separately for 95900 and 95903 if both studies are performed on the same nerve would be considered unbundling which could lead to an unreimbursed claim (at best) or audits and accusations of fraudulent coding (at worst).

Note: Separate billing of 95900 and 95903 is allowed if the two studies are performed on different nerves. See "Note" on page 45 for more information on unbundling CCI edits.

Version 8.1 of CCI contains about 85 changes (additions and deletions) to comprehensive/component code edits in the CPT code ranges often used by neurologist.

There are few revisions to edits involving the 60000-series codes in version 8.1 of CCI.

Spinal puncture codes 62270* (Spinal puncture, lumbar, diagnostic) and 62272* (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]) now include anesthesia service 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture).

Code 64612 (Chemodenervation of muscles[s]; muscles[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) now includes use of an operating microscope (+69990, Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) as a component of the chemodenervation. A companion code of 64612, 64614 ( extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]), bundles 12 new codes, including 69990 as well as all injection codes 64413-64450 (Injection, anesthetic agent ).

New edits affecting 70000-series codes are more plentiful in CCI 8.1 than those affecting the 60000 series.

Tomography codes 70460-70470, 70481-70482, 70487-70488 and 70491-70492 (Computerized axial tomography ) bundle 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour), while tomography angiography codes 70496-70498 (Computed tomographic angiography ) bundle 01916 (Anesthesia for diagnostic arteriography/venography).

MRA procedures 70544-70549 (Magnetic resonance angiography ) likewise include 01916. In addition, catheterization procedures 36000 and 36011, venipuncture procedures 36406 and 36410 (Venipuncture ) and infusion/injection procedures 90780 and 90783-90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected] ) may no longer be billed separately with 70547.

Other neurology-relevant codes that now bundle 90780 include magnetic resonance codes 70552-70553 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem] ), tomography codes 72126-72127 (Computerized axial tomography, cervical spine), 72129-72130 ( thoracic spine ) and 72132-72133 ( lumbar spine ), as well as the following: