Neurology & Pain Management Coding Alert

Version 8.0 of the national Correct Coding Initiative (CCI) is available and went into effect Jan. 1, 2002, and will remain active until March 31. The edits are mandatory for all Medicare carriers and are increasingly followed by third-party payers.
 
The first-quarter edits are not extensive. Of the approximately 8,400 changes (total additions and dele-tions in all code categories) only a handful affect neurology practices.
 
CCI groups edits into two categories: Comprehensive/Component and Mutually Exclusive. Comprehensive/component edits describe those procedures (component codes) that are included as a part of or incidental to (i.e., bundled) a more extensive procedure (the comprehensive code) and therefore should not be reported separately. According to CCI, mutually exclusive edits describe those codes 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. Only one method of repair may be chosen because to report both would represent an unrealistic circumstance. During each quarter, CCI adds or deletes code combinations (i.e., creates new edits or nullifies previous edits) from either the comprehensive/ component or mutually exclusive categories.

 
Fifteen codes used in neurology are newly designated comprehensive codes. Muscle biopsy codes (20200-20206) now include fine needle aspiration with or without imaging guidance (10021, 10022). Magnetic resonance spectroscopy (76390) and non-invasive physiologic studies of extracranial arteries (93875) now bundle reconstruction of computerized axial tomography, magnetic resonance imaging or other tomographic modality (76375).
 
Sleep study codes (95805, 95806, 95808, 95810-95811) now include a host of procedures, ranging from nocturnal penile tumescence and/or rigidity testing (54250) to electrocardiogram (93000) to electroencephalogram. In all cases, the edits formalize what has been normal medical practice by preventing unbundling of component services included in the sleep study codes.
 
Note: For more information on coding sleep studies, see Stay Alert When Selecting Diagnosis Codes for Sleep Studies and Polysomnography, Neurology Coding Alert, October 2001.
 
Similarly, motion analysis codes (96000-96004) now include all electromyography (EMG) codes in the range 95861-95872 and 95875 (ischemic limb exercise test with serial specimens[s] acquisition for muscle metabolite[s]). Each of these edits includes a CCI status indicator of 1, however, which means that modifier -59 (distinct procedural service) may be used to report an EMG that is separate from motion analysis if the two are not related. In addition, 96001 is now included in its base code, 96000.

 
CCI version 8.0 bundles infusion and injection codes (90780-90784 and 90788) into 56 individual codes from the anesthesia (00100-01999), surgery (10021-69990) and radiology (70010-79999) sections of CPT. Such bundling of infusion/injection procedures has become a staple of CCI. These edits will have little impact on neurologists, who would not normally provide the services that the infusion/injection codes are bundled into. Similarly, electroencephalogram during nonintracranial surgery (95955) is newly bundled to 19 anesthesia codes.
 
As previously outlined, electroencephalogram codes 95816 and 95819 are now included as a part of polysomnography codes 95808, 95810 and 95811. Also, EMG codes 95860-95872 and 95875 are bundled into the motion analysis codes.
 
Code 96115 (neurobehavioral status exam ...) is officially bundled to all codes in the 90801-90857 range, as well as 90865, 90880 and all E/M codes (99201-99456). Code 96155 (health and behavior assessment ... family) is subject to identical edits. The edits include a 1 status indicator, which means a modifier is usually allowed, but these services are no longer separately payable.

Additional Changes 
 
 
Injection code 20550 ( tendon sheath, ligament, ganglion cyst) no longer includes fluoroscopic guidance (76003) as reflected in CPT 2002.
 
There are no edits for mutually exclusive code pairs (either additions or deletions) affecting codes commonly used by neurologists.
 
Note: The CCI is available by subscription from the National Technical Information Service (NTIS) in print or as a CD-ROM in searchable (.pdf) format. Contact NTIS (1-800-363-2068 or http://www.ntis.gov/products/hcfa.htm) for more information.