Neurology & Pain Management Coding Alert

Revised directions for 64990 to 64995 change ultrasound, T12-L1 reporting.

Remember to check for updated or revised guidelines when preparing to use your new code books for 2011, not just code descriptors. CPT 2011 includes new details for coding some common EEG procedures, so read on to stay on the right track.

Watch Changes to EEG Guidelines and Descriptors

You report several EEG codes such as 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (... greater than 1 hour) based on the amount of recording time. But what constitutes recording time?

Jeffrey Cozzens, MD, professor and chair of the neurosurgery division of Southern Illinois University School of Medicine and a presenter at the AMA's CPT and RBRVS 2011 Annual Symposium in Chicago, addressed the issue during his presentation about neurosurgery and neurology changes for 2011. Keep two things in mind when calculating recording time for these EEGs:

• Recording time is when the recording is underway and the healthcare provider is collecting data.
• Recording time excludes set-up and take-down time.

Difference: Other EEG codes, however, focus on the amount of physician time rather than recording time. Watch for that specificity in guidelines for 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes or brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) and +95962 (... each additional hour of physician attendance [List separately in addition to code for primary procedure). If the physician is in attendance for a total of 30 minutes or less, only report 95961 and append modifier 52 (Reduced services) to indicate he didn't fulfill the full hour represented by the code.

Revisions: Two codes for special EEG tests now specify who attends during the procedure:

• 95953 -- Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended
• 95956 -- Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse.

According to information on the American Academy of Neurology website, "CMS required clarification in the codebook for codes 95953 and 95956, specifically about which services was attended. Code 95953 was created for ambulatory EEG, which is not attended by a technologist or nurse. Code 95956 is used now for monitoring without video, e.g., in the ICU, and that service is attended during the recording."

Don't Miss Revised Paravertebral Injection Notes

The introduction of new codes for paravertebral facet joint injections in 2010 (64490- 64495) meant changes to how you reported related codes. During the CPT and RBRVS Symposium, Douglas G. Merrill, MD, MBA, of the American Society of Anesthesiologists, pointed out two revised guidelines dealing with paravertebral facet (spinal) joint procedures.

Ultrasound clarification: Instructions in CPT 2010 directed you to report 64999(Unlisted procedure, nervous system) if the provider used ultrasound guidance during paravertebral facet joint injections. The AMA released a correction later in 2010, and the CPT 2011 clarifies the situation. If your provider used ultrasound guidance when administering paravertebral facet joint injections, report the appropriate code(s) from 0213T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance ...).

T12-L1 change: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for an injection to the T12-L1 joint, or nerves innervating that joint. New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single) instead.

In addition, the 2011 guidelines direct providers to report paravertebral facet joint injections performed without image guidance with the appropriate trigger point injection code. Submit either 20552 or 20553 (Injection(s); single or multiple trigger point[s]...) rather than from the 20550 -- 20553 code range as directed for 2010.

Reminder: Code paravertebral facet joint blocks (64490-64495) bilaterally if the physician injects two sides at the same level. "These are unilateral blocks," Merrill explained. Use modifier 50 (Bilateral procedure) for bilateral paravertebral facet injection procedures.

Take Care When Reporting Somatic Nerve Injections

Merrill noted three somatic nerve injections identified through CMS's "Fastest Growing" screen:

• 64415 -- Injection, anesthetic agent; brachial plexus, single
• 64445 -- ... sciatic nerve, single
• 64447 -- ... femoral nerve, single.

"Increased utilization can be indications of incorrect coding," explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. "These may become target areas for the OIG Workplan, such as facet joint injections and transforaminal epidural injections have been in recent years."

Wait and see: Merrill indicated that the information to clarify correct coding is forthcoming. Watch for details from the AMA and in future articles of Neurology and Pain Management Coding Alert.