Neurology & Pain Management Coding Alert

While you may not always be pleased withadvancements in healthcare reimbursement policy, you can at least count on some positive advances in healthtechnologies and medicine.

When your neurologist uses new technologies, you may be tempted to reach right for the unlisted codes. But if you're not making good use of CPT Category III codes, you might be slighting your practice in some small but significant ways.

Follow these three tips for using Category III codes compliantly, and pick up the reimbursement your neurologist deserves.

CPT creates Category III codes for emerging technology, services, or procedures that might not be widely performed.

CPT requires you to bill with the codes in order to track their usage and effectiveness. If a technology (and therefore a code) becomes more widely used, it has the potential to become a Category I. "Codes in this section of the CPT may or may not eventually receive a Category I CPT code," says Lisa Center, CPC, a billing professional with Mt. Carmel Regional Medical Center in Pittsburg, Kan.

Category III codes are temporary codes. "They are archived five years from the date of their publication or revision in the CPT code book, unless it is demonstrated that a temporary code is still needed," Center says.

CPT requires providers to report the code that accurately describes the services provided; i.e., providers must report the Category III code rather than reporting a CPT code that is "close" to the code listed, or reporting one of the unlisted CPT codes. "You must pick the Category III code for a particular service before using an unlisted Category I CPT code," Center says.

CPT includes unlisted procedure codes to allow you to report procedures for which there is no specific CPT descriptor available. In contrast, Category III codes have a specific descriptor. Payment for such claims, however, is not automatic in either case.

Example: Your neurologist wants to bill for services provided to a critically ill patient from offsite via interactive video conference. CPT lists Category III codes 0188T (Remote real-time interactive video-conferenced critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +0189T (... each additional 30 minutes) for the video conference service.

Because the CPT manual provides a code for the offsite care your neurologist performed, you should not use the typical CPT codes for critical care (99291-+99292, Critical care, evaluation and management of the critically ill or critically injured patient ...).

Because the AMA releases Category III codes in January and July, you may find a number of additions or deletions between published CPT manuals.

Tip: As a neurology coder, you should watch for a handful of Category III injection codes that went into effect Jan. 1, 2010, although they didn't make the cut-off date for inclusion in CPT 2010. Watch for more on this in an upcoming issue.

More info: Check the AMA website for updates and descriptions for all Category III codes: www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf