Neurology & Pain Management Coding Alert

No grace period for the new year means that now's the time to learn about additions

CPT 2005 will contain relatively few changes for neurology coders, but you'll want to pay special attention so you don't confuse new variations of evoked potentials, Doppler imaging, and neurostimulator programming codes with their pre-2005 counterparts.

Get ready now: Keep in mind that for 2005, neither Medicare payers nor practices billing Medicare payers are allowed the usual 90-day "grace period" to transition to the new codes. Beginning on Jan. 1, 2005, you must use CPT 2005 exclusively for Medicare payers, according to CMS transmittal 95 (February 2004).

For Central Motor EP, Turn to 95928/95929

Beginning Jan. 1, you should report 95928 (Central motor evoked potential study [transcranial motor stimulation]; upper limbs) or 95929 (... lower limbs), as appropriate - rather than an unlisted-procedure code - for central motor evoked potential (EP) studies. The new codes join previously listed EP procedures 92585/92586 (auditory EPs), 95925-95927 (somatosensory EPs) and 95930 (visual EP).

"These new codes allow us to code for interpretation of the motor pathway centrally from the cortex through the spine and on to the peripheral muscle," says Gloria Galloway, MD, associate professor of neurology at the Children's Hospital and OSU in Columbus, Ohio, as well as director of the intraoperative monitoring program at the Children's Hospital and one of the authors of the CPT proposal for codes 95928/95929.

"In this sense, motor EP differs from the sensory or SEP codes, which allow interpretation of the sensory tracts and sensory cortical responses," Galloway says. "We know that patients undergoing spinal surgeries are typically at risk for both motor and sensory deficits, so monitoring both pathways makes sense."

Coding advice: You should report a single unit of 95928/95929 for any and all sites that the neurologist tests during a single session. The codes are bilateral. For example, if the neurologist tests a total of four sites on the upper limbs (two on the right arm and two on the left arm), you would report 95928.

Which diagnoses and conditions call for 95928/95929? In the outpatient setting,motor neuron diseases such as amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS).

And, neurologists may use central motor evoked potential studies intraoperatively to monitor procedures involving scoliosis instrumentation, intramedullary spinal cord tumors, brain tumor resection, laminectomies or other surgical procedures to repair spondylosis and spinal stenosis, Galloway says. Therefore, CPT 2005 will allow you to report 95928/95929 in addition to +95920 (Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).

Neurostim Codes Break Out Deep-Brain Services

If you're billing for electronic analysis of implanted neurostimulators, you'll have to be extra careful about your terminology from now on, because CPT will add two new, time-based codes for these procedures: