Neurology & Pain Management Coding Alert

Correct Coding Initiative (CCI) version 14.0 creates several new edits for neurostimulator and analysis-programming codes, but the good news is they shouldn't take a bite out of your bottom line. Here's what you need to know.

"None of these edits should create significant reimbursement problems, although some neuropsychiatrists might disagree," says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, Pa.

Here's why: The only edits that apply to your neurology practice are the bundling of new 2008 code 96125 (Standardized cognitive performance testing [e.g., Ross Information Processing Assessment] per hour of a qualified healthcare professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report) as a Column 2 code (component) into the various other Column 1 (comprehensive) CNS assessment and test codes, says Marvel J. Hammer RN, CPC, CCS-P, ACS-PM, CHCO, with MJH Consulting in Denver.

The following are the test codes Hammer refers to:

- neurofunctional testing 96020

- psychological testing 96101-96103

- assessment of aphasia 96105

- developmental testing 96110-96111

- neurobehavioral status exam 96116

- neuropsychological testing 96118-96120

- health and behavior assessment 96150-96151.

These edits match the other edits CCI implemented in 2006 and 2007 for the various other CNS assessment and test codes, Hammer says. She notes that you can use a modifier to bypass these edits compliantly as long as the provider separately performs and documents the assessments and tests. And being able to override the edits means you-ll see little or no impact on reimbursement.

Example: A neurologist performs 96125 testing on a patient with a traumatic brain injury and uses the patient's results to determine that it is medically necessary to have the patient complete additional neuropsychological testing to assist in a better evaluation of the patient's cognitive function. At the same session, the neurologist has the patient perform a separate 96118 (Neuropsychological testing [e.g. Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test], per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report).

You can report both 96118 and 96125, Hammer says, but you have to append modifier 59 (Distinct procedural service) to the lesser 96125 service to indicate that the two tests were separate and distinct.