Neurology & Pain Management Coding Alert

Remember the one code that can help your pre-configured NCS billing.

January brought some changes to the CPT and HCPCS codes that may be getting on your nerves. Take this three-part neurology coding challenge and give your worries a rest.

Test yourself: Of the most notable changes so far this year, chemodenervation is high on the list, with headache-inducing bundling edits. Plus, if your neurologist uses a pre-configured nerve conduction study (NCS) as the basis for a standard NCS, you'll want to watch for one code in particular.

Test Your 2010 Neurology Code Change Knowledge:

Question 1: Which injection codes can you not report -- even if you use a modifier -- when reporting 64614 (Chemodenervation of extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]), according to Correct Coding Initiative (CCI) edits.

Question 2: When your neurologist injects 100 units of Dysport, which code would you report? How many times do you report it?

Question 3: Which code would you use for a pre-configured nerve conduction study?

Resolve Your CCI Bundling Issues for Chemodenervation

Answer 1: According to CCI 16.1 edits, you cannot report the following codes with chemodenervation of extremity (64614):

Single spinal injection, not via indwelling catheter (62310 ��" Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic, 62311 -- ... lumbar/sacral [caudal])

Spinal injection, with catheter placement (62318 -- ...cervical or thoracic, 62319 -- ... lumbar, sacral [caudal])

Somatic nerve block injection (64400-64483 -- Injection, anesthetic agent; somatic nerves)

Sympathetic nerve block injections (64505-64530 -- ...autonomic nerves).

Reason: CCI bundles these injections as column 2 codes into 64614, the column 1 code. A "0" modifier indicator is assigned to all of these bundles, which means you cannot bypass these edits using a modifier.

When performing a chemodenervation injection, a physician commonly injects small amounts of the botulinum toxin drug, such as Botox, at different sites throughout the same muscle group.

You'll easily recognize a chemodenervation procedure from your neurologist's documentation. Neurologists use chemodenervation to temporarily interrupt the communication between nerves and muscles, explains Leslie Johnson, CCS-P, CPC, owner of the billing and coding Web site AskLeslie.net.

Number of Units Counts in Botulinum Toxin Reporting

Answer 2: If your neurologist uses a botulinum toxin to interrupt pain signals in a patient's limbs, neck, or back, Dysport is one of three toxins he may use. Each of these drugs has its own J code. Dysport's HCPCS code is J0586 (Injection, abobotulinumtoxinA, 5 units).

Note: You'll notice in the code description a mention of five units. When using J0586, note that the number of the drug units injected is crucial to coding. So if your neurologist injected 100 units of onabotulinumtoxinA into a patient's right splenius capitis muscle, and 100 units into the right sternocleidomastoid muscle, you should report 40 billing units of service for J0586 -- that's 200 divided by 5 or the total number of units of the toxin injected divided by the number of units described by the HCPCS code.

Dysport is the brand name for the neurotoxin abobotulinumtoxinA. Before 2010, you reported Dysport using J3490 (Unclassified drugs). Dysport comes in two preparations: a single-use, sterile 500-unit vial typically used for cervical dystonia and a single-use, sterile 300-unit vial commonly used for cosmetic purposes in treatment of glabellar lines.

Don't forget: Your neurologist should clearly document the amount of botulinum toxin injected and the specific muscles  injected. If there is any unavoidable wastage, there should also be documentation of the specific amount wasted. You'll report the wasted amount using modifier JW (Drug amount discarded/ not administered to any patient), says Brian Fornataro, a coding and billing professional with Medi-corp in Cranford, NJ.

Reason: Botulinum toxin's shelf life is typically considered to be only four hours after reconstituting or opening, so the rest should be discarded.

Get Help on Pre-Configured Nerve Conduction Study Coding

Answer 3: You'll use 95905 (Motor and/or sensory nerve conduction, using preconfigured electrode array[s], amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report) to report preconfigured nerve conduction studies.

This code eliminates the need to report a pre-configured NCS with using a vague unlisted code: 95999 (Unlisted neurological or neuromuscular diagnostic procedure). Remember that 95905 is based on per limb rather than reporting per nerve or nerve branch, which is the case with the standard 95900-95904 codes.

Warning: You should not be using modifiers 50 (Bilateral procedure) or 51 (Multiple procedures) when reporting 95905. The code carries a "0" bilateral status indicator, which means you should not report this procedure as bilateral. Code 95905 and the other NCS codes are also exempt from the multiple procedure discount, so you should not append modifier 51 to these codes either.

Two common conditions the NCS helps diagnose and manage include carpal tunnel syndrome (354.0) and cubital tunnel syndrome (354.2, Lesion of ulnar nerve).

The pre-configured device is also useful in assessing conditions such as:

• Diabetic polyneuropathy (250.6x, Diabetes with neurological manifestations or 249.6x, Secondary diabetes mellitus with neurological manifestations with 357.2 (Polyneuropathy in diabetes)
• Sciatica (724.3).