Neurosurgery Coding Alert

Edits bundle J0670 with 64405, 64450, and 64493.

Nerve block and neurolytic agent injection codes are among those addressed in Correct Coding Initiative (CCI) edits (effective July 1) which could affect your claims success.

CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. Here's what you need to know about edits to prevent denials and delays.

EEG, Pump Refills Appear in NME Edits

Column 1/Column 2 edits, also referred to as non-mutually exclusive edits (NMEs), include pairs of procedures your physician could reasonably perform during the same session. Whether you report both procedures, however, depends on the modifier indicator for the pair.

EEG recording: Non-mutually exclusive edits in CCI 16.2 pair 95830 (Insertion by physician of sphenoidal electrodes for electroencephalographic [EEG] recording) with HCPCS codes J0670 (Injection, mepivacaine HCL, per 10 ml) and J2001 (Injection, lidocaine HCL for intravenous infusion, 10 mg). The pairs carry a "1" modifier indicator, so you can break the edit by appending modifier 59 to the J code when appropriate. Otherwise, simply report 95830.

Kit included: Two other edits bundle A4220 (Refill kit for implantable infusion pump) into procedures 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]) and 95991 (... administered by physician). Both bundling edits carry a modifier indicator of "0," so payers who also use CCI edits to process provider claims will deny any claims with both codes reported on the same beneficiary on the same date of service by the same provider.

Steer Clear of Separate Mepivacaine HCL

Your physician might rely on Mepivacaine HCL (Carbocaine), a local anesthetic similar to Lidocaine, for nerve, soft tissue and/or joint injections, but you can no longer separately report the medication for some procedures. CCI edits now bundle J0670 (Injection, mepivacaine HCL, per 10 ml) with many common injections such as:

Flip side: CCI 16.2 classifies the J0670 edits with a modifier indicator of "1." When justified, you can report both codes and append modifier 59 (Distinct procedural service) to unbundle the pair.

Other Work Includes Paravertebral Facet Injection 

CCI edits now bundle two paravertebral facet joint injection codes with chemodenervation injections and many nerve destruction procedures. The paravertebral injection codes affected are:

Procedures paired with 0213T and 0216T range from 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) to 64650 (Chemodenervation of eccrine glands; both axillae).

In certain situations, you may need to report chemodenervation injections for other sites. "Although uncommon, if a destructive procedure is performed at a location other than the paravertebral joints during the same operative session and CCI lists a modifier indicator "1" for the site, you may report both the tracking code and the separately identifiable site, the latter appended with modifier 59," advises Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Most of the edit pairs carry a "0" modifier indicator, but CCI lists a few with modifier indicator "1." Check the full CCI file to verify whether you can use a modifier to break specific edits.

Mutually Exclusive Edits Also Hit 0213T-0218T

Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive edits, as well. CCI 16.2 pairs each of the new category III codes using ultrasound for guidance with the corresponding paravertebral facet joint injection codes using fluoroscopy or CT guidance

This implies that you should report "only a single code for performance of a diagnostic or therapeutic injection using a particular guidance method, whether it is ultrasound or fluoroscopy/CT," says Przybylski. "If methods of image-localization are combined," report only "the more definitive method used," he adds.

The edits include:

64490-64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic ...) and 64493-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral ...).

Each edit carries a "0" modifier indicator, so you can't use modifier 59 to override the bundling.

CCI 16.2 includes more than 16,800 edits. Check the latest version at www.cms.gov to ensure you correctly report procedures.