Neurology & Pain Management Coding Alert

Diagnostic testing forms the core of neurology practice. Because such testing assumes that a definitive diagnosis has not been determined, assigning ICD-9 codes can prove frustrating. Although recent changes to CMS guidelines have given neurologists more options for reporting posttest diagnoses, the best solution is to note carefully the patient's chief complaint and all related signs and symptoms. Documentation of this type supports the neurologist's CPT coding by showing medical justification, leading to better patient care and fewer claim denials. Be Sure to Explain "Why" If the diagnosis(es) linked to a particular procedure or service cannot sufficiently explain why that procedure or service was reasonable and necessary, the claim will likely be rejected. Although many diabetics have neuropathy, a diagnosis of only diabetes (250.xx) will not support diagnostic testing for neuropathy. Without a definitive diagnosis, you should use signs and symptoms codes to show that the patient has a problem that requires further investigation and to provide justification for diagnostic testing, says Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., a healthcare consulting firm in Dallas, Ga. Generally, the more signs and symptoms that can be documented as long as they pertain to the current problem the better. Signs and symptoms codes are found primarily in Chapter 16, Volume I of ICD-9 ("Symptoms, Signs, and Ill-Defined Conditions," 780-799), although there are exceptions (e.g., 729.5, Pain in limb). In the example of the diabetic patient, symptoms such as loss of coordination (781.3), numbness and tingling (782.0) or pain in the feet (719.47) suggest that neuropathy may be present and that further testing, such as nerve conduction studies (NCS) or electromyography (EMG), is reasonable and necessary. Regardless of the results of testing, the tests should be reimbursed because medical necessity was demonstrated. Avoid Screenings and Rule-Outs Except in very limited circumstances (e.g., preoperative screenings), Medicare will not pay for screenings even if the test reveals a problem that requires further treatment. By definition, a screening involves testing or examination without direct medical evidence (signs and symptoms) that such services are necessary. In these cases, you should report the reason for the test (e.g., V80.0, Special screening for neurological conditions) as the primary diagnosis. The results of the test, whether negative or positive, may be recorded as additional diagnoses. For example, if you perform a screening for CTS and the results come back positive, you may report 354.0 as an additional diagnosis (with V80.0 as the primary diagnosis). Similarly, physicians in private practice should avoid "suspected" or rule-out diagnoses. For example, a patient visits the neurologist complaining of numbness, dryness and "coldness" in the left wrist. In addition, the patient's history reveals that his or her work involves many hours per day [...]