Neurology & Pain Management Coding Alert
CPT 2003 Brings Evolutionary Not Revolutionary Changes for Neurology
CPT 2003 brings numerous text additions and code revisions but no major or unexpected changes for neurology practices. Primarily, modifications for the new year attempt to clarify and formalize already established coding principles. New Codes Added to E/M Services E/M services undergo several revisions for 2003. Specifically, CPT now further differentiates critical care according to patient age. New codes 99293 (Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) and 99294 (Subsequent pediatric critical care) describe critical care for patients 31 days to 2 years of age, while previously established codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 ( each additional 30 minutes [list separately in addition to code for primary service) continue to describe critical care for patients older than 24 months. The same definition of critical care ("A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition") applies regardless of patient age and does not change for 2003. Note: Low birth weight service code 99299 is new for 2003 and describes "Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weight of 1500-2500 grams)." As in previous years, 99298 describes the same services for a neonate of less than 1,500 grams. 'Miscellaneous Services' Codes May Not Pay CPT 2003 also introduces two "Miscellaneous Services" codes, although Medicare probably won't reimburse for them, presumes Douglas Jorgensen, DO, CPC, a practicing physician in Manchester, Maine, and chairman of the Osteopathic Medical Economics Committee: If Medicare denies these codes "on the same basis as the after-hours codes [99050-99054], there's still a chance that private insurers will reimburse," Jorgensen suggests. CPT adds 99600 (Unlisted home visit service or procedure) to report an otherwise unlisted visit or procedure provided in the patient's home. This code joins 19 revised codes (99551-99569) to describe home infusion procedures and services (e.g., 99552, Home infusion for pain management [epidural or intrathecal], per visit). 70000-Series Changes Clarify Usage Minor text modifications to the 70000 (radiology) series codes refine definitions and provide new information. Specifically, descriptors for 72125, 72128, 72131 and 72192 (imaging of cervical spine, thoracic spine, lumbar spine and pelvis, respectively) now state "computed tomography" rather than, as in 2002, "computerized axial tomography." As explained by CPT Changes 2003, "Typically, direct acquisition images are obtained in the axial plane for computed tomographic studies, but in certain instances direct acquisition may be obtained in other planes." The elimination of the term "axial" thereby serves to clarify that 72125, 72128, 72131 and 72192 are correct for direct acquisition imaging in any plane (e.g., axial, coronal, sagittal or multiplanar). Revised Text Affects Medicine Codes Many changes in CPT's Medicine portion (90000 series) occur in the text accompanying individual codes rather than in the code descriptors. For example, a new parenthetical reference accompanying 90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) directs physicians, "For incontinence treatment by pulsed magnetic neuro-modulation, use Category III code 0029T [Treatment(s) for incontinence, pulsed magnetic neuromodulation, per day]," which has been added for 2003. Similarly, new text heading the electroen-cephalography (EEG) subsection (95812-95830) instructs, "EEG codes 95812-95822 include hyperventilation and/or photic stimulation when appropriate." In addition, CPT further clarifies that routine EEG codes 95816-95822 include 20 to 40 minutes of recording, while extended EEG 95812 and 95813 include recording times in excess of 40 minutes. Several code descriptors in the EEG section undergo changes as well. Code 95812 (Electroencephalogram [EEG] extended monitoring ...) now specifies "41-60 minutes" (for 2002, the descriptor read "up to one hour"). To reflect the addition of the text heading described above, descriptors for 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) and 95819 (including recording awake and asleep) no longer note, "including hyperventilation and/or photic stimulation when appropriate" (application of the codes is not affected). Code 95822 now describes EEG "recording in coma or sleep only," rather than the previous "in sleep only." To clarify appropriate use, EEG 95827 for 2003 reads simply "all night recording" instead of last year's "all night sleep only." To clarify proper use, needle electromyography of thoracic paraspinal muscles (95869) now instructs "excluding T1 or T12." Again, the instructions serve to state explicitly what has been common coding practice for many years without altering the code's application. As in the past, you may report only a single unit of 95869 regardless of the number of levels tested, advises Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. Helpful new text following +95920 (Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]) directs physicians and coders away from that code and toward 95829 for electrocorticography, 95955 for intraoperative EEG during nonintracranial surgery, 95961-95962 for intraoperative functional cortical or subcortical mapping, and 95970-95975 for intraoperative neurostimulator programming and analysis. Once again, the text seeks to clarify existing guidelines rather than establish new ones. New instructions accompanying 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]) direct, "For refilling and maintenance of an implantable infusion pump for spinal or brain drug infusion, use 95990." The descriptor for 96530 has been modified to reflect the availability of 95990 (see below). Code 95990, new for 2003, describes, "Refilling and maintenance of implantable pump or reservoir for drug deliver, spinal (intrathecal, epidural) or brain (intra-ventricular)." Note that this code applies only to pumps/reservoirs designed to deliver drugs to the spine or brain. As explained in CPT Changes 2003, "Medical practice has changed to allow new routes of drug delivery via an implant. To accommodate these advances ... 95990 was established." For systemic drug therapy, apply 96530 as described above. To report analysis and/or reprogramming of implantable infusion pumps, regardless of type, continue to report 62367-62368.
According to AMA's CPT Changes 2003: An Insider's View, 99291/99292 reflect "the additional work related to the age of these young patients due to small size, previous therapy, and limited mechanisms of physiological compensation."
In addition, CPT 2003 revises neonatal intensive care codes 99295 and 99296 to reflect the availability of 99293 and 99294. The neonate codes now specify initial/subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, "30 days of age or less." According to revised guidelines, 99295 and 99296, "may be reported only once per day, per patient. Once the neonate is no longer considered to be critically ill, the Intensive Low Birth Weight Services codes for those with present body weight of less than 2500 grams (99298, 99299) or the codes for Subsequent Hospital Care (99231-99233) for those with present body weight over 2500 grams should be utilized."
In addition, new text accompanying 95827 instructs physicians, "For 24-hour EEG monitoring, see 95950-95953 or 95956" and "For digital analysis of EEG, use 95957." Although the instructions are new, they serve only to direct physicians and coders to the proper codes and do not represent revised coding guidelines.
Code 95875 has undergone its second revision in two years, with the descriptor now specifying "Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metobolite(s)" [emphasis added]. By using the plural "muscles" instead of "muscle" (as in 2002), CPT apparently seeks to notify physicians not to report multiple units of 95875 when conducting studies on more than one muscle, says Tiffany Schmidt, JD, policy director for the American Association of Electrodiagnostic Medicine.
Neurology & Pain Management Coding Alert
- CPT 2003 Brings Evolutionary Not Revolutionary Changes for Neurology
CPT 2003 brings numerous text additions and code revisions but no major or unexpected changes [...] - Avoid OIG Scrutiny:
Master Work Plan Problem Areas
Because the U.S. Office of Inspector General (OIG) intends to scrutinize consolidated billing in 2003, [...] - You Be the Coder:
Report Post-Test Diagnosis
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - News Brief:
OIG to Check SNF Billing and Incident-To
According to its recently released 2003 Work Plan, the U.S. Office of Inspector General (OIG) [...] - Reader Question:
Modifier -25 Is Key to Sleep Study and E/M
Question: May we report an E/M service on the same day as a sleep study [...] - Reader Question:
Private Payers May Reimburse Telephone Codes
Question: Our physician spent 20 minutes during office hours on the phone providing advice and [...] - Reader Question:
Code All Services for In-Office Emergency
Question: Recently, an allergy patient presenting for evaluation of carpal tunnel experienced anaphylactic shock while [...] - Reader Question:
Reporting EEG and Ultrasound Exam Interps
Question: The neurologists in our group practice interpret electroencephalograms (EEG) and carotid ultrasound exams at [...]
