Neurology & Pain Management Coding Alert

A recent CMS update brings some pleasant surprises for neurology coders that will make your job a little easier. We tell you how to use these latest changes to get a head start on bilateral reimbursement coding.

"Effective April 1 -- with the second-quarter change implementation -- many of your 644xx somatic nerve procedure codes are changing their bilateral status indicator to -1,- " which means Medicare will allow you to report bilateral services and will process them for payment, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, with MJH Consulting in Denver.

"Previously, these codes carried a -0- status indicator, which meant that whether you reported the code with modifier 50 (Bilateral procedure) or with modifiers RT and LT (Right side and Left side), Medicare would only allow processing of a single injection," Hammer says.

Opportunity: This is a prime example of how a little legwork can help you play it safe. Always check the Medicare Physician Fee Schedule Data Base, says Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network, and executive officer on the AAPC's National Advisory Board. It's a simple way to keep up with the indicators that let you know which codes are valued as unilateral -- where modifier 50 is applicable -- as well as the codes that are already valued as bilateral where no modifier 50 is indicated, Grady says.

Tip: You can search the fee schedule online at http://www.cms.hhs.gov/pfslookup/.

The news gets even better, Hammer says. CMS made the changes retroactive to Jan. 1.

She says that some of the procedures listed include 64405 (Injection, anesthetic agent; greater occipital nerve), 64415 (- brachial plexus, single), 64416 (- brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration), 64425 (- ilioinguinal, iliohypogastric nerves), 64447 (- femoral nerve, single) and 64448 (- femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration).

Example: If the neurologist performs bilateral femoral nerve blocks, you should report 64447 (Injection, anesthetic agent; femoral nerve, single) with the appropriate modifier.

Depending on your payer, you may report 64447-50; 64447 and 64447-50; or 64447-LT and 64447-RT.

Where to look: A complete list of the codes that this change affects begins on page 6 of the transmittal. Check it out on the CMS Web site at http://www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf.

Don't count your coding chickens before they hatch, though. In spite of all this good news, you may still need to be aware of one potential setback.

"We need to remember that, although these changes are applicable to Medicare for 2008 dates of service, many commercial payers only update their fee schedule files annually," Hammer says. She notes that many payers may not implement any change until January 2009 at the earliest.

There's still one more important reason for you to be excited. If you report the category II tracking codes, this latest CMS update also includes a new tracking code series -- 1130F-1137F. Each of the new codes in this series is designated to capture specific performance measures related to back pain and function assessment.

What you-ll use the codes for: Code 1130F (Back pain and function assessed, including all of the following: Pain assessment and functional status and patient history, including notation of presence or absence of "red flags" [warning signs] and assessment of prior treatment and response, and employment status) is the sole new code from this series designated specifically for function assessment, while you use the remainder of the codes -- 1134F through 1137F -- to describe specific durations for periods of back pain.

Where to find them: You can find a complete list of the specific codes and their descriptions on page 8 of the transmittal (http://www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf).