Neurology & Pain Management Coding Alert

Stay sharp on some of coding's more puzzling answers.

How did you do? Check your answers, and take note of any problem areas.

With or Without Myelopathy Makes a Difference.

Solution 1: A. You can rely on 721.0 (Cervical spondylosis without myelopathy) for cervical spondylosis as well as cervical arthritis, cervical osteoarthritis, and cervical spondylarthritis.

Look to 721.1 (Cervical spondylosis with myelopathy) if your provider includes documentation of myelopathy, which is damage to the spinal cord from compression or another condition.

Watch Out For Changes in 2009

Solution 2: B. As tempting as it might be to choose answer A, the most likely culprit in this example is the code combination. More than likely your physician marked the CPT code, 96413, on the charge ticket in error. An IV steroid infusion would be considered a therapeutic infusion as the medication does not meet the CPT criteria for chemotherapy administration. You can't report +90766 (Intravenous infusion ... each additional hour) without one of the accepted "initial hour" CPT codes, either 90765 (... initial, up to 1 hour) or +90767 (... additional sequential infusion, up to 1 hour).

Use 90766 when there are additional hours of non-chemotherapy infusion, and report it only with 90765 or 90767.

Take note: Remember the code changes for 2009. Codes 90765-7 have been deleted for 2009; use codes 96365-7 instead starting Jan. 1.

Q Code Changed to J in 2008

Solution 3: True. The correct code for the Tysabri drug is J2323 (Injection, natalizumab, per 1 mg). The generic name for Tysabri is natalizumab. HCPCS 2008 replaced Tysabri's temporary Q code with this J code, going into effect on Jan. 1, 2008.

FYI: Typically, the patient receives the drug via intravenous infusion every four weeks in either the inpatient or outpatient setting. Code the infusions with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and possibly the add-on code +96415
(... each additional hour [List separately in addition to code for primary procedure]), if appropriate.

While 96413 and 96415 specify "chemotherapy administration," these codes also apply to infusions of monoclonal antibody agents and other biologic response modifiers, and Tysabri falls into this category.

72275 Includes 77003

Solution 4: True. You may report 72275 (Epidurography, radiological supervision and interpretation) only if the physician performs the separate diagnostic study, including the permanent radiologic images of the epidural space, and documents the diagnostic interpretation in a written report.

CPT states that 72275 includes 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction), so you would not report both codes together for the same service, says Stacy Gregory, RCC, CPC, owner of Gregory Medical Consulting Services in Tacoma, Wash.

Remember: There is a possibility of reporting both codes, but it would have to be fluoroscopy in one spinal region and epidurography in a totally separate spinal region, such as a cervical fluoroscopy and lumbar epidurography.

Tip: Correct Coding Initiative (CCI) edits bundle 72275 into the epidural injections codes. You may override the edit with a modifier if your documentation supports the separate nature of 72275.

Count Limbs for Accurate Coding

Solution 5: False. When you code the EMG diagnostic study your neurologist performs, choose the EMG code reflecting the total number of limbs tested.

If the patient has carpal tunnel syndrome (CTS) in one hand, your neurologist might perform an EMG study of the single upper extremity. You would report one unit of 95860 (Needle electromyography; one extremity with or without related paraspinal areas).On the other hand: To diagnose a patient with CTS in both hands, your neurologist might perform needle EMG testing on both upper extremities. You could code one unit of 95861 (... 2 extremities with or without related paraspinal areas). Report only one unit of service of 95860"95864 per patient for a given exam. The complete extremity needle EMG study code includes all muscles tested in the particular extremity/extremities, with or without the related paraspinal muscles.

Watch Out for Utilization Guidelines

Solution 6: A. If your neurologist performs facet joint injections at the right and left side of the same spinal level -- the right C5-C6 and left C5-C6 in the example -- report 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) with a single unit of service with modifier 50 appended for bilateral injections.

Just be careful you don't exceed your carrier's utilization guidelines, says Heather Corcoran with CGH Billing in Louisville, Ky. You should not report the bilateral facet joint injections as one unit of the first or single level code (64470), and one unit of the add-on code (64472), for "each additional level." This would incorrectly report the neurologist's bilateral facet joint injections.