Neurology & Pain Management Coding Alert

For all you busy neurology practices trying to keep up with the latest coding facts, here are two items you don't want to miss: ICD-9 had added V12.42 to describe CNS infections, and revisions to the Physician fee schedule database include a new bilateral status modifier for 64640.

1. 2006 ICD-9 Changes Now Available

Beginning in October, neurology practices will have a new diagnosis code available for use: V12.42 (Personal history, infections of the central nervous system).

As with most other V codes, you probably won't use V12.42 as a primary diagnosis, but it could provide valuable secondary or signs-and-symptoms information, especially for diagnostic testing needed to establish a primary diagnosis of central nervous system (CNS) infection, for instance.

"We haven't had a lot of great ways to describe this in the past, and the new V codes are going to be a great help," says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.

The May 4 Federal Register includes a complete list of more than 140 new ICD-9 codes for 2006, along with more than a dozen deletions and 25 revisions. As in past years, the trend is toward greater and greater diagnosis specificity.

Adding specificity to diagnosis coding "is very much a conscious effort," says Amy Blum with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which designs the ICD-9 codes.

In spite of the strides being made toward diagnosis availability, with the possible exception of the inclusion of V12.42 and new codes to describe sleep disorders, neurologists won't feel much impact in the coming year. That's because the changes are more specific to other specialties, including nephrology and bariatric surgery, among others.

Learn more: You can find a complete list of the new, deleted and revised ICD-9 codes in tables 6A, 6C and 6E of the May 4 Federal Register, available online at www.access.gpo.gov/su_docs/fedreg/a050504c.html.
 
Scroll down to "Centers for Medicare & Medicaid Services" and "Proposed Rules" to find the link.

2. CMS Revises fee schedule

Keep an eye on claims for 64640 (Destruction by neurolytic agent; other peripheral nerve or branch).
 
CMS transmittal 558, released May 6, contains updates to the 2005 Physician Fee Schedule Database that change this injection procedure's bilateral surgery indicator from "0" to "1."

Good news: The change means that neurologists who perform 64640 can expect extra compensation for bilateral claims with modifier -50 (Bilateral procedure) appended.

In the past, Medicare would not pay an increased fee for such bilateral injections. Based on the fee schedule Update, however, neurologists can now expect 150 percent of the unilateral fee for bilateral injections reported using 64640-50.

CMS transmittal 558 outlines updated Fee Schedule information for several dozen CPT codes, although the only change specific to neurology practice involves 64640.

Learn More: To view the complete text of CMS transmittal 558, visit the CMS Web site at www.cms.hhs.gov/manuals/pm_trans/R558CP.pdf.