Neurology & Pain Management Coding Alert

The most recent update (version 9.0) of the national Correct Coding Initiative (CCI) is now available, covering the first three months of the new year. Although massive, with about 40,000 new edits, and including for the first time new and revised codes for 2003, version 9.0 is mostly worry-free for neurologists coding primarily from the "medicine" (90000-series) portion of CPT.

CCI has deemed several medicine codes describing infusion or injection mutually exclusive of similar procedures designated with level-III HCPCS codes for Medicare reporting. For example, any physician reporting diagnostic infusion as described by 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) cannot report HCPCS codes Q0083, Q0084 or Q0085 (Chemotherapy administration ...). Similarly, 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous) is exclusive of all of the above codes, as well as Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit).

Identical or substantially similar edits also affect chemotherapy and infusion codes 96400-96425, as well as pump maintenance procedures 96520-96530. In short, when you report HCPCS codes Q0081-Q0085, CCI will exclude most codes describing injections, infusions and other procedures related to chemotherapy.

Also, with the revision of 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]) and the addition of 95990 ( spinal [intrathecal, epidural] or brain [intraventricular]) in CPT 2003, CCI now includes an edit to prevent physicians from reporting both codes for the same procedure. Rather, the physician must choose one code based on location (systemic or spinal/brain). If you report both 96530 and 95990 for the same date of service, only the lesser procedure (or "Category II" code, in this case 96530) will gain reimbursement.

CCI now bundles infusion code 90780 and related infusion/injection codes 90781-90788 to a host of other procedures. Unlike the mutually exclusive edits described above, in which the edited code pair describes two methods of reporting the same service, in this case CCI considers the infusion/injection integral to the more extensive service and therefore not separately reportable.

Almost all codes into which CCI bundles the infusion/injection codes are injection procedures (for example, 20612, Aspiration and/or injection of ganglion cyst[s] any location; and 64416, Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration). Here again, because of the number of edits affecting 90780-90788 (90780 alone is a component of 120 new edits, for example), the best strategy is to consult the CCI before billing these procedures with a separate injection or infusion procedure of any kind.

The new CCI includes electroencephalography (EEG) as described by codes 95812-95822, as well as electro-corticogram 95829, as a part of nearly every anesthesia procedure listed in CPT (00100-01995) and may not be reported separately. It now also bundles 95812, 95813 and 95829 to 61623 (Endovascular temporary balloon arterial occlusion, head or neck ). The edits are of minimal interest, however, because neurologists normally would not bill for such procedures in addition to an EEG.

Version 9.0 includes neurobehavioral status exams (96115) and spinal puncture (62270*) as components of new-for-2003 critical/intensive care codes 99293, 99294 and 99299, just as CCI previously classified them as a component of other critical care services.

In the sole deletion from CCI 9.0 of any significance to neurology practices, the new version no longer bundles 93875 (Noninvasive physiologic studies of extracranial arteries, complete bilateral study [e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis]) to 93880 (Duplex scan of extracranial arteries; complete bilateral study). CCI contains no instructions to resubmit claims previously rejected based on this edit, however.