Neurology & Pain Management Coding Alert

Do not forget that your clinician may perform the block to diagnose occipital nerve pathology and then perform a more definitive step to treat the same. For example, your physician may perform a block and then request the patient to maintain a pain diary and return to the clinic for a check on the success of the block. "Many payers now require providers to include in their post injection documentation, the patient's response to the diagnostic procedure, i.e. pain level, percentage of pain relief and/or capability to perform previously painful maneuvers," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co.

If the block provides desired relief, your clinician may decide to repeat the block or administer the block into another occipital nerve. "There is no difference in reporting these on subsequent visits as the global period is 0 days," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Make sure you provide adequate documentation in support of this entire procedure. "Since the GON (greater occipital nerve) and LON (lesser occipital nerve) injections are typically performed in the office, it is important to keep track of performance of an E&M service on the same day," says Przybylski. "If the decision to perform the block is based on the medical decision making performed at that visit, then the E/M service is separately reportable with the -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service...) modifier.

On the other hand: If the patient is asked to specifically come to the office for the performance of the injection, the E/M service is considered bundled into the procedure code."

Medicare differs in the reporting of the E/M service. "Medicare takes a slightly more restrictive stance in regard to meeting the 'significant and separately identifiable' criteria," says Hammer. "Chapter 8 of the 2012 Medicare NCCI Manual states 'If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E/M service. However, a significant and separately identifiable E/M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.' All of the occipital nerve injection codes have a 000 global period."