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. Mutually Exclusive Code Pairs 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 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. New 60000-Series Edits There are few revisions to edits involving the [...]