Neurology & Pain Management Coding Alert

The story on Correct Coding Initiative (CCI) 16.0 doesn't end with the new bundling edits. You'll also want to watch for several deletions and column swaps that could affect your neurology coding.

The good news: There are not many that apply to neurology this quarter. But if you don't focus in on the ones that do affect your neurology practice, you could be throwing deserved reimbursement out the door. Dig into the bundle deletions and revisions to ensure you get your neurologist all the money he deserves.

"Often the first quarter CCI updates include bundling edit deletions that involve codes that are no longer valid," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver.

CCI 16.0 contains the expected deletions of bundles involving the old facet injection codes (64470 and 64475, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve ...).

The deletions in version 16.0 also include all of the CCI edits that involved the consultation codes, including both office and outpatient (99241-99245, Office consultation for a new or established patient ...) and inpatient (99251-99255, Inpatient consultation for a new or established patient ...). CCI deleted these bundles because Medicare changed the code status indicator for these E/ M services to "I" or not valid for Medicare. "Medicare no longer processes these codes for reimbursement and requires providers to report these E/M services with alternate CPT codes," Hammer explains. "It only makes sense that the Medicare CCI edits no longer need to include these non-covered codes."

"For some specialties, reimbursement will actually increase as version 16.0 has lifted the edits on bundling some E/M services into specialty codes," says Sarah L. Goodman, MBA, CPC-H, CCP, FCS, president/CEO of SLG Consulting in Raleigh, N.C.

Stay tuned: "It's not uncommon to have more deleted edits in the second and third quarter," Hammer says.

Prepare to Swap Pairs

You may have a little more to watch for when dealing with CCI's swapped pairs. These occur, Hammer says, when the CCI panel discovers a mistake between which code in a pair should have been paid.

Swapped pairs do exactly what their name implies: the Column 1 and Column 2 designations for the pairs have flip-flopped, so you'll need to pay closer attention to which procedure is now comprehensive versus component.

Example: CCI swapped the bundling edit between 64450 (Injection, anesthetic agent; other peripheral nerve or branch) and 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). What this means is that now 64450 is in column 1 and 20550 is in column 2 rather than vice versa. This swapped edit is effective retroactive back to the effective date of Jan. 1, 1996, the date that CCI introduced the edit.

This is also the case with the EMG codes (95863, 95864, and 95869), and the intra-operative monitoring (IOM) CPT code, +95920 (Intraoperative neurophysiology testing, per hour). The 16.0 CCI edits swapped these codes -- the IOM add-on code is now in column 2 and the EMG codes are in column 1. As with the previous example, this swap has an effective date retroactive to Jan 1, 1996.

Crucial point: If you attempt to unbundle an edit with a modifier -- modifier 59 (Distinct procedural service), for example -- be sure to double-check these swapped pairs to ensure you append the modifier to the right code. If CCI allows you to bypass the edit with a modifier and your neurologist's documentation supports separately reporting the codes, append the modifier to the Column 2 code. "If the provider puts the modifier on the Column 1 code in error, the Medicare contractor will deny the Column 2 code and not allow processing for payment," Hammer says.

Good news: If you do report the modifier incorrectly, you may still have the opportunity to appeal the denial with the corrected information.