Neurology & Pain Management Coding Alert

Tip: Appending modifier 25 can help save annual visit with some claims.

Until now, you've been able to report some services (such as muscle and range-ofmotion testing) separate from annual wellness visits (AWVs). That will no longer be the case effective July 1, thanks to the latest round of Correct Coding Initiative (CCI) edits.

CCI version 17.2, which takes effect July 1, offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC.

Combine Muscle Test With Annual Visit

HCPCS introduced two new annual wellness visit (AWV) codes in 2011: G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) and G0439 (... subsequent visit). If your provider has been coding separately for the wellness visit and certain muscle or range-of-motion tests, you might need to change your practice.

According to CCI 17.2, AWVs include:

• 95831-95834 -- Muscle testing, manual (separate procedure) with report ...
• 95851-95852 -- Range of motion measurements and report (separate procedure) ...

Explanation: CCI lists the reason for bundles as "Standards of medical/surgical practice." The AWV services include measurement of the patient's height, weight, BMI (Body Mass Index) or waist circumference if appropriate, blood pressure, and other routine measurements as deemed appropriate based on the patient's medical/ family history. A provider could perform muscle strength and range of motion testing as a component of performing these or other AWV requirements. Services that are integral to another service (such as these services being integral to an AWV) are component parts of the more comprehensive service and are not coded separately.

The phrase "separate procedure" in each descriptor does not automatically mean you can report the code on its own. According to CPT®'s Medicine Section guidelines, "The codes designated a 'separate procedure' should not be reported in addition to the code for the total procedure or service of which it is considered an integral component...."

Good news: The edits carry a modifier indicator of 1, meaning you can use a modifier to separate these bundles when both services were medically necessary and performed as distinct procedures. Before reporting both services, you'll need to verify that your provider performed the muscle testing and/or range of motion testing during a separate encounter or session.

Steer Clear of Polysomnography With NCS

If your provider sometimes completes a nerve conduction study (NCS) during the same encounter as polysomnography, double check CCI edits before reporting both services.

CCI 17.2 classifies reporting some polysomnography codes with 95905 (Motor and/or sensory nerve conduction, using preconfigured electrode array[s], amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report) as "misuse of column two code with column one code." The affected polysomnography codes include:

• 95810 -- Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
• 95811 -- Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist
• 95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist.

Translation: Normally, you shouldn't report these three polysomnography codes with NCS code 95905. Special circumstances might allow you to report both services with a modifier, however, since the edits carry a modifier indicator of 1. "Neurologists rarely --" or never --" perform the diagnostic testing represented by 95905," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. "They almost always perform the standard nerve conduction studies (NCS) represented by 95900- 95904. The new edits may be somewhat of a 'housekeeping' change to keep the edits similar to other NCS procedures with column 2 codes bundled into the column 1 polysomnography codes."

Verify if Specialty Treatment Injections Are Allowed

Many of the other new bundling edits in CCI 17.2 involve three HCPCS codes:

• C9273 -- Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
• C9800 -- Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies
• G0428 -- Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex).

More than 130 edits list G0428, C9273, or C9800 as the comprehensive codes associated with procedures including EEGs (95812-95922 and 95829), joint injections (20600-20610), and epidural injections (62310-62319). The edits also encompass virtually all somatic nerve injections (64400-+64484) and paravertebral facet joint injections (64490-+64495). You're your provider performs these services during the same encounter, report the HCPCS code (C9273, C9800, or G0428) instead of the other procedure. Because the edits are so extensive and might carry either a modifier indicator of 1 or 0, check the edits yourself before filing your claim.

Information: For the complete version of CCI 17.2, visit www.cms.gov/NationalCorrectCodInitEd.