Neurology & Pain Management Coding Alert

Don't be fooled. The neurology section of CPT 2008 may include only a few changes, but they-ll make a real difference in your coding -- especially if you routinely code for cognitive performance or neuropsychological testing.

You-ll only have one new code to learn for neurology testing when CPT 2008 goes into effect: 96125 (Standardized cognitive performance testing [e.g., Ross Information Processing Assessment] per hour of a qualified healthcare professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report).

You could use this new code for traumatic brain injury patients, but don't be surprised if you never report it.

"Most neurologists don't use these cognitive testing codes, so this should have very little impact," says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside. "But you need to know about it since it's new."

CPT 2006 established four new codes to differentiate the various modalities for performing neuropsychological exams. One of these codes (96118) has a slightly revised descriptor, effective Jan. 1, 2008:

Old language: Previous versions of the code stated, "both face-to-face time with the patient and time interpreting test results and preparing the report."

Here's the difference: The new descriptor clarifies that the time you report with 96118 must represent face-to-face testing time or time spent interpreting those test results and preparing the report. In other words, you can't report 96118 for face-to-face time unless your physician is conducting the test.

If your physician routinely bills for phone calls to patients or to coordinate a patient's care with other medical professionals, be sure to check out changes in the new E/M section.

What's gone: CPT 2008 deletes codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists] ...).

What's added: You have three new time-based codes, however, for similar services to patients:

"It's my understanding that phone calls are not a covered service by most insurance companies," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher. "However, if a phone call is documented and referenced at the next visit, it can usually count toward the medical decision-making portion of the E/M code."

CPT 2008 includes a similar option for technology-savvy physicians who offer online E/M services: 99444 (Online evaluation and management service provided by a physician to an established patient, guardian or healthcare provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

Four other new codes are similar to 99441-99444 but represent services by a "qualified nonphysician healthcare professional":

Jandroep and Busis agree that payers probably won't reimburse these new codes, but you could still report the codes to track your staff's services.

"My PA or a CRNP could use these codes," Busis says. "The key is what -qualified- means. We will have to see what the Medicare fee schedule says about them."

Editor's note: CPT 2008 also includes two new Category II codes that will help you track a patient's fall risk. Watch for more information in a future issue of Neurology Coding Alert.