Neurology & Pain Management Coding Alert

Hint: 20526 and 20527 override 130+ other codes.

The latest Correct Coding Initiative (CCI) edits went into effect Jan. 1, 2012, with hundreds of new edits pertaining to pain management. Focus on changes to injection pairs and nerve destruction to ensure you choose correctly for some of your most common pain management procedures.

Primary Joint Injection Goes First

Some of pain management specialists' most common procedures include joint and tendon injections. Before reporting these for your provider in 2012, check out some CCI edits affecting those codes:

• Joint injection codes 20600 (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]), 20605 (... intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]), and 20610 (...major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) are the Column 1 codes with new procedure code 20527 (Injection, enzyme [e.g., collagenase], palmar fascial cord [i.e., Dupuytren's contracture]).
• Tendon injection procedures 20526 and 20527 are designated as the Column 1 codes for multiple edit pairs. The coupled procedures range from abscess aspirations and therapeutic injections to cast applications, venipuncture, and anesthetic injections, to name a few. Sift through the edits to see which ones might apply to your providers.

Paravertebral Facet Joint Nerve Destruction Trumps 100+ Codes

Other edits focus on nerve destruction procedures. More than 100 new edit pairs are listed for these areas in CCI 18.0, so take time to review all the changes for ones that apply to your providers. Two areas to watch include:

• Neurolytic agent nerve destruction procedures (64600-64680) override a number of other injections your provider might administer. These include tendon and trigger point injections (20550-20553) and short-latency EP study codes 95938 and 95939.
• Edits list codes 64633-64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s] with imaging guidance [fluoroscopy or CT] ...) as the Column 1 code for more than 100 other procedures. The Column 2 codes in the pairs range from trigger point injections (20552-20553) and venipuncture procedures to epidural placements (62310-62319), diagnostic or therapeutic nerve injections (64400-64530), image guidance (such as fluoroscopic and CT) and more. The edits are too extensive to list here, so take time to go through the CCI changes and make note of the ones that pertain to your group.
• Reminder: When CCI edits pair two codes together, you'll typically report the Column 1 code instead of the Column 2 code. The Column 1 code either represents a procedure that includes the services of the Column 2 code, or represents a procedure that "outweighs" the Column 2 code and should be reported alone.

Modifier check: Each pair of CCI codes carries either a modifier indicator of "0" or "1." A modifier indicator of "1" means you might sometimes be able to bypass the edit with a modifier and be paid for both services (such as modifier 59, Distinct procedural service).

"Knowing what the proper exceptions are to qualify the use of a 59 modifier will save your practice money," says Dawn Shanahan, CPC, CASCC, CHC, assistant compliance officer at Florida Gulf to Bay Anesthesiology Associates in Tampa. "It costs your practice money every time a case is denied and has to be looked at, corrected or adjusted off due to an error."

"Let your providers know if you see a pattern of unbundling," Shanahan adds. "Having good communication between the coding/billing staff and the provider is a must."