Neurology & Pain Management Coding Alert

Reduced service? Don't reduce your coding finesse.

Neurology coders are quite familiar with reporting procedures that go over and above the standard code descriptors in CPT^®, but what happens when a procedure stops short of fulfilling the code's requirements? That's when modifier 52 can come in handy.

What it is: You should use modifier 52 (Reduced services) to indicate a partial reduction or discontinuation of procedures and services - in other words, when a service comprises less work than the CPT^® descriptor. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.

Consider the following examples for using this modifier.

Example 1: Your practice performs electroencephalogram (EEG) video monitoring for three hours and interprets the results, so you report 95813 but the payer denies it, saying that the documentation does not support the code submitted.

Do this:  You would not be correct to submit code 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour) because it doesn't represent video recording and interpretation. Instead, you should report 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic [EEG] and video recording and interpretation [e.g., for presurgical localization], each 24 hours) with modifier 52 appended, as directed by the CPT^® section guidelines.

Example 2: The provider performs a complex spinal cord neurostimulator test and subsequent programming, lasting 53 minutes. The practice reports 95972 appended with modifier 52.

Don't do that: You will not need modifier 52 with code 95972 (Electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; complex spinal cord, or peripheral [i.e., peripheral nerve, sacral nerve, neuromuscular] [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming) for reporting this service.

The code includes the services for subsequent programing of the neurostimulator. As with many services, there is a range of times applicable for the provision of the service and elimination of the specific time component recognizes the range that exists.

No time component:  The confusion may stem from the fact that 95972's descriptor used to include the phrase "up to 1 hour," but that was removed from the descriptor last year, so you do not need to heed the time advice when selecting a code for this service.