Neurology & Pain Management Coding Alert

Streamline your unlisted-procedure code claims, and ensure your neurologist gets reimbursed even without dedicated codes, by following these three pointers.

Any time you file a claim using an unlisted-procedure code (for example, 92700 [Unlisted otorhinolaryngological service or procedure]), include a separate report that explains, in simple, straightforward language exactly what the physician did.

Keep in mind: Insurers consider claims for unlisted-procedure codes on a case-by-case basis, and they determine payment based on the documentation you provide.

Good idea: You may even want to include diagrams or photographs, in order to better help the insurer understand the procedure. Some practices recommend highlighting or making notes on the actual report indicating where in the body of the report the provider describes the unlisted procedure.

An insurer will decide to pay an unlisted-procedure claim by comparing your procedure description to a similar, valid CPT procedure code with an established reimbursement value.

Rather than leave it up to the insurer to determine which code is the "next closest" for reimbursement, you may help your practice by explicitly making reference to a valid code that is similar in physician work, malpractice risk and practice expense. After all, the treating neurologist is best equipped to make this determination.

For example: For the Epley maneuver, many providers look to code 97530 (Therapeutic activities, direct [one-on-one] patient contact by the provider [use of dynamic activities to improve functional performance], each 15 minutes) as a basis for their fees and expected payment.

This will help relate the procedure performed to an existing procedure as support for reimbursement. You also should explain how your procedure differs to show why you didn't choose the existing code, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.

FYI: Basing your fee on a similar procedure is helpful in claims processing, but not mandatory.

If your neurologist uses equipment and/or techniques for which there is no dedicated CPT code, you may be able to enlist the manufacturer's aid to receive appropriate reimbursement, says Randall Karpf with East Billing in East Hartford, Conn. 

You should also look into the applicable medical specialty societies for supporting information.

Manufacturers often maintain free information and help lines to advise physician practices on how to approach insurers regarding new technologies. Use caution when applying manufacturers- suggestions, however, because you are responsible for the accuracy of your claims. You should never misrepresent a claim to gain a payment.