Neurology & Pain Management Coding Alert

Prior to 2001, neurologists who worked with patients recovering from brain injuries or psychiatric disorders had only one code to use for cognitive and sensory skills training 97770 (development of cognitive skills to improve attention, memory, problem solving, includes compensatory training and/or sensory integrative activities, direct patient contact by the provider, each 15 minutes). However, it has been deleted in CPT 2001.

Cindy Dumond, a coding and billing specialist with Medical Billing Services in Jacksonville, Fla., which supports approximately 75 neurologists in the state, reports Having two different procedures incorporated into one code was a payment problem because the two procedures, 97532 and 97533 [see below for new code definitions], that were grouped into 97770 would never be used together and would generally be used by two different patient populations.

New CPT 2001 Codes

Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based coding and reimbursement firm that supports more than 500 physicians nationwide, states that 97532 (development of cognitive skills to improve attention, memory, problem solving, [includes compensatory training], direct [one-on-one] patient contact by the provider, each 15 minutes) is intended to report therapy often required for adults with diagnoses of psychiatric disorders, brain injuries, or cerebrovascular accidents. This type of cognitive skills training allows individuals to live independently, return to work and function safely in their environment.

Parman also reports that 97533 (sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct [one-on-one] patient contact by the provider, each 15 minutes) is intended to outline the sensory integrative techniques that help patients respond to environmental demands. This code is associated with pediatric populations but can also be used with adults, of which the most common diagnoses are autism (299.0x), developmental disorders, attention deficit disorders, cerebral palsy (343.0-343.9), and motor apraxia (784.69).

ICD-9 Coding

The diagnosis codes for patients with psychiatric problems can be tricky when a neurologist is attempting to obtain reimbursement. Some insurance carriers assume that any condition from the mental disorders (290-319) section of the ICD-9 should be treated by a psychiatric professional. Reimbursement can be achieved by neurologists if they call mental-health disorders what they are. Every appropriate diagnosis code should be on the claim.

There is a diagnostic manual that can help neurologists called the Diagnostic and Statistical Manual for Primary Care (DSM-PC). It is a collaboration of medical, behavioral, and mental-health communities and is based on the principle that psychosocial issues are part of medical care, and physicians need to be reimbursed if they treat such conditions. Note: To order the DSM-PC, call 800-433-9016.

As always, coders should contact insurance carriers to find out if there is a list available for codes [...]