Neurology & Pain Management Coding Alert

Your pay won't change, but modifier shifts to better reflect procedure.

If you code for motor evoked potential testing, you'll need to be up to speed on a bilateral modifier change that could change your reporting. New modifier indicators are in effect as of Oct. 1, 2011 for these procedures, thanks to Medicare Physician Fee Schedule updates.

Prepare for '0' to '2' Modifier Status

The modifier indicator change affects codes 95928 (Central motor evoked potential study [transcranial motor stimulation]; upper limbs) and 95929 (... lower limbs). Previous schedules listed bilateral indicator "0" for the codes; now the schedule lists bilateral indicator "2."

Details: At first glance indicators "0" and "2" seem the same because they both mean that payment adjustments for bilateral procedures do not apply. The difference is that procedures with indicator "2" do not allow for payment adjustment because the RVUs associated with the code are already based on a bilateral procedure.

"In either case, the codes cannot be reported as bilateral," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver. "It's mainly the underlying reason that has changed."

"The indicator changed for both the global code listing and all of the underlying component codes," Hammer adds.

Don't Jump to Bilateral Reporting

As noted by the inclusion of "limbs" in the descriptors, you shouldn't report codes 95928 or 95929 as bilateral procedures.

"The information that Medicare includes in the 'definition' of the '0' and '2' bilateral indicators is information for the Medicare contractor on processing the claim if a provider does report the service as bilateral," Hammer explains. "If a provider does incorrectly report these procedures as bilateral, Medicare will not process the evoked potentials testing as bilateral."

Additionally: Medicare's Medically Unlikely Edits (MUEs) correspond with this mindset by listing one unit of service for 95928 and 95929.