Neurology & Pain Management Coding Alert

Remember: Always check the modifier indicator.

Now that the Correct Coding Initiative (CCI) 25.0 edits are out, you’ll want to see how these edits will impact your practice’s reimbursement this year.

As is typical of the first round of bundlings for a new year, many of the new CCI 25.0 edits focus on the updated CPT^® codes. Check out which edits you need to be aware of in your neurology practice.

Check Out These 95976, 95977 Edits

You will see several new edits surrounding the following new electronic analysis of implanted neurostimulator codes:

• 95976 — Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional
• 95977 — … with complex cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional.

Do not report 95976 in conjunction with 95977, according to CPT^® instructions.

95976: The following codes are bundled into 95976 with a modifier indicator of “0”:

• 36591 — Collection of blood specimen from a completely implantable venous access device
• 36592 — Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified
• 96523 — Irrigation of implanted venous access device for drug delivery systems.

Remember: A modifier indicator of “0” means you cannot separate the edit with a modifier.

Don’t miss: On the reverse side, 95976 is bundled into some codes as well. You’ll find that 95976 is now considered part of 95971, 95972, and 95977, and you cannot separate these edits with a modifier because these edits have a “0” indicator.

95977: These codes are bundled into 95977 with a modifier indicator of “0”:

• 36591;
• 36592,
• electronic analysis of implanted neurostimulator pulse generator codes 95970-95972;
• 95976; and
• 96523.

Both 95976 and 95977: Additionally, you will see some edits where 95976 and 95977 are bundled into other codes. For example, codes 95976 and 95977 are bundled into these codes with a modifier indicator of “1”:

• 63685 — Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
• 63688 — Revision or removal of implanted spinal neurostimulator pulse generator or receiver
• 64553 — Percutaneous implantation of neurostim­ulator electrode array; cranial nerve
• 64568 — Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator)-64570 (Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator
• 64590 — Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling
• 64595 — Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver.

Modifier indicator of “1”: When the modifier indicator is “1,” this means that you may be able to report both codes of an edit pair under certain circumstances by using a modifier. For example, you can overcome the edit, if appropriate, with the use of a modifier such as modifier 59 (Distinct procedural service), explains Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Caveat:  Just because you can add a modifier, that doesn’t mean you should. Be sure you have the supporting documentation for requesting payment for both codes before adding a modifier to the bundled pair.

“Modifier 59 and other CCI-associated modifiers should not be used to bypass a CCI edit unless the proper criteria for use of the modifier 59 are met,” Falbo adds. “Documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that is used.”

You can use modifier 59 when the surgeon performs the bundled procedures for different anatomic sites/regions, different organs, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ, Falbo explains.

Caution: You should never append modifier 59 to an evaluation and management (E/M) service.

Apply New These 95983 and +95984 Edits

For 2019, you received new codes 95983 (Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional) and +95984 (… with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)).

Take a look at the new edits regarding codes 95983 and +95984.

Both 95983 and +95984: These codes are bundled into 95983 and +95984 with a modifier indicator of “0”:

• 36591,
• 36592,
• 95970, and
• 96523.

Additionally, you will see edits where 95983 and +95984 are bundled into the following codes with a modifier indicator of “1”: 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver).

Remember: If the neurologist performs the electronic analysis with programming of an implanted brain neurostimulator pulse generator/transmitter, you would report new codes 95983 and +95984.

Don’t miss: Code +95984 is an add-on code, which means that you should never report this code for the initial programming period. Instead, you will report it right after the appropriate standalone code for the initial 15 minutes of programming, explains Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.