Neurology & Pain Management Coding Alert

Question: We recently received denials for brainstem auditory evoked potential (BAER) based on inappropriate ICD-9 coding. Is there any way to access a list of acceptable diagnoses?


New Jersey Subscriber

Answer: Whenever an explanation of benefits suggests improper pairing of CPT and ICD-9 codes, the first thing you should look up is the local coverage determination (LCD) for that specific carrier. This will often spell policies for specific procedures and may even link acceptable pairs of CPT and ICD-9 codes.

If the LCD doesn't give you the information you need, you can then turn to Medicare's national coverage determinations (NCDs). Reason: Medicare contractors are required to follow NCDs, but if an item or service is not specifically mentioned in an NCD or Medicare manual, the individual carrier can determine their own policy.
 
In the case of BAER (92585 [Auditory evoked potentials for evoked response audiometry and/or testing of the nervous system; comprehensive] and 92586 [...limited] ), the main indication for testing is most often the presence, or suspicion, of an acoustic neuroma (225.1). Medicare outlines a wide scope of additional acceptable ICD-9 codes, including:

- 333.0-333.99: Other extrapyramidal disease and abnormal movement disorders
- 340-341.9: Multiple sclerosis and other demyelinating diseases of central nervous system
- 377.30-377.39: Optic neuritis
- 386.00-386.04: Meniere's disease
- 386.2: Vertigo of central origin
- 388.1-388.32: Noise effects on inner ear and Tinnitus
- 388.5: Disorders of acoustic nerve
- 389.10-389.2: Sensorineural hearing loss
- 780.4: Dizzines and giddiness
- 781.0: Abnormal involuntary movements

Watch out: Adjusting ICD-9 coding for reimbursement purposes can leave you open to charges of fraud. A carrier's LCD and Medicare's NCD can be used as guidelines, but an accurate ICD-9 code, even when not reimbursable, should always be used.