Neurology & Pain Management Coding Alert

Although neurologists regularly face denials for diagnostic procedures to assess potential stroke victims, you can improve reimbursement with three steps:

1. Select procedures carefully. 2. Establish medical necessity. 3. Check individual payer policies prior to billing. Step One:Choose the Procedure Depending on the individual patient and circumstances, the neurologist may use any number of diagnostic procedures to test for stroke or potential stroke damage.

Applicable codes include:

70544 Magnetic resonance angiography, head; without contrast materials(s)

70545 with contrast material(s)

70546 without contrast material(s), followed by contrast material(s) and further sequences

70551 Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material

70552 with contrast material(s)

70553 without contrast material, followed by contrast material(s) and further sequences

93875 Non-invasive physiologic studies of extracranial arteries, complete bilateral study (e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis)

93880 Duplex scan of extracranial arteries; complete bilateral study

93882 unilateral or limited study

93886 Transcranial Doppler study of the intracranial arteries; complete study

93888 limited study. When any of the above procedures are performed in the hospital or using equipment not owned by the treating physician, modifier -26 (Professional component) must be appended to show that the neurologist interpreted the results only.

For example, says Steven Dibert, MD, a neurologist at the Neuroscience and Spine Center in Gastonia, N.C., and a member of the board of directors of the American Society of Neuroimaging and of the American Academy of Neurology/Neuroimaging Section, for a patient with stenosis of an artery in the head, the neurologist may order magnetic resonance angiography (MRA) (e.g., 70544), or magnetic resonance imaging (MRI) (e.g., 70551 or 70553) to view the blood vessels of the head and check where the stroke took place and whether it was embolic (material lodged in the artery caused the stroke) or thrombotic (the artery closed off within the brain itself). Note: Most neurologists interpret MRIs infrequently. Similarly, cerebrovascular studies (93875, 93880 and 93882) may be used to examine the carotid arteries, while the transcranial Doppler tests (93886 and 93888) are appropriate to examine the intracranial arteries. Step Two:Establish Medical Necessity Generally, a confirmed stroke diagnosis is not available prior to testing. Therefore, medical justification for testing must be based on the patient's signs and symptoms, says Cindy Parmen, CPC, CPC-H, co-owner of Coding Strategies Inc., a healthcare consulting firm in Dallas, Ga.

Typical signs and symptoms for stoke victims include cerebral atherosclerosis (437.0), paralysis (344.9), hemiplegia (342.91), loss of vision (369.9), occlusion of arteries (434.9x or 433.1x, as applicable), transient cerebral ischemia (435.9) aneurysms (442.9), stenosis (447.1), speech problems (784.5) and injury to blood vessels (904.9). Individual payers [...]