Neurology & Pain Management Coding Alert

The American Medical Associations (AMA) CPT changes for 2001 indicate a more straightforward approach for coding many neurological procedures such as botox injections and computed tomography (CT) and magnetic resonance (MR) scans.

The AMA has changed a lot of wording for clarification and added some important codes, explains Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based billing and reimbursement firm. The modifications outlined in CPT 2001 will take effect Jan.1, 2001, for Medicare, although it may take longer for other carriers to adopt them. Parman advises coders to work closely with carriers to determine when to begin implementing the new codes. It is never too early for coders to begin brushing up on the revisions and some of the relative changes are outlined below.

New Chemodenervation Code

Neurology providers who use botulinum toxin (botox) injections to treat spastic muscle disorders should be pleased with the introduction of a new code for injections to the extremities and/or trunk muscles. Neil A. Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at UPMC Shadyside in Pittsburgh, states that the AMA created the new code because there were no specific codes designated for chemodenervation to the extremities.

Many experts feel that the creation of 64614 necessitated the accompanying change in 64612 (chemodenervation of muscle[s];muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]). The words chemodenervation of muscle end plate have been replaced with chemodenervation of muscle, which is a more accurate statement of the procedure.

The new definition for 64614 is chemodenervation, extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis).

The code does not include needle electromyograms (EMGs), nerve conduction studies, or the medicine itself. As before, the botox should be coded using J0585.

Computerized Tomographic Angiography Codes

According to Busis, the new computed tomography angiography codes are a benefit because they will encourage institutions to perform this procedure. These new codes give institutions an additional choice for what kind of angiogram they will perform on a patient.

The new codes are as follows:

70496 computed tomographic angiography, head, without contrast material(s) and further sections, including image post-processing; and

70498 computed tomographic angiography, neck, without contrast material(s), followed by contrast material(s) and further sections, including image post-processing

As there were no specific codes (and no direct route to gain reimbursement) for CT angiography prior to CPT 2001, many neurologists were hesitant to perform these procedures. Now that these codes have been assigned, neurologists can perform these procedures with much greater confidence that they will be reimbursed.

Magnetic Resonance Angiography Codes

Neurology coders will also have new MR angiography codes. The significant change here is that [...]