Neurosurgery Coding Alert

You can choose only one guidance procedure per claim

If your neurosurgery practice performs guidance procedures when providing chemodenervation injections, get ready for a big change. Starting Jan. 1, 2006, you-ll have two dedicated add-on codes to describe these services.

On Jan. 1, Ditch 95870

 For the remainder of 2005, you can continue to report 95870 (Needle electro-myography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) for electromyographic (EMG) guidance with chemodenervation injections 64612-64614 (Chemodenervation of muscle[s] ...).

Note: Some payers require that you report 95999 (Unlisted neurological or neuromuscular diagnostic procedure), rather than 95870, for EMG localization.

The problem: Medicare, through the National Correct Coding Initiative, places severe restrictions on the use of EMG codes with chemodenervation codes, and physicians have been concerned that they would lose the ability to bill for guidance entirely in 2006 if the AMA failed to deliver dedicated guidance codes.

The solution: When CPT 2006 becomes effective this January, you will be able to choose from one of two new add-on codes--instead of 95870 (or 95999)--to describe guidance with chemodenervation. (The exact five-digit code numbers have not yet been finalized, but should appear soon. Keep an eye on Neurosurgery Coding Alert for complete information when it becomes available.):  

- +9585x--Electrical stimulation for guidance in conjunction with chemo-denervation (list separately in addition to code for primary procedure)

- +9585y--Needle electromyography for guidance in conjunction with chemo-denervation (list separately in addition to code for primary procedure).

Code 9585y, in particular, better describes guidance for chemodenervation than does 95870. -EMG guidance for chemodenervation is not really a diagnostic study as 95870 describes,- says Marvel J. Hammer RN, CPC, CHCO, president of MJH Consulting in Denver.

The verdict is still out: Although dedicated codes to describe guidance for chemodenervation are a step in the right direction, some experts are withholding judgment, at least for now.

-The goodness or badness of the new codes is solely dependent on the associated RVUs [relative value units], and we won't know those for a while,- 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, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. In other words, if 9585x and 9585y don't pay, they won't really improve anything.

Choose One Guidance Type per Claim

If the AMA's draft guidelines hold true, you should follow two rules when reporting 9585x and 9585y: 

1. The new codes describe add-on guidance procedures for use with 64612-64614 only. Revised instructions following the descriptors for 64612-64614 will specifically guide you to 9585x and 9585y -for chemodenervation guided by needle electromyography or muscle electrical stimulation.-

2. You cannot report both 9585x and 9585y during the same session.

In addition, CPT will specifically forbid the use of 9585x and 9585y with current EMG codes 95860-95870.

Look for Changes to 64613, Too

You should be aware of proposed text changes to the descriptor for 64613, as follows (deleted items are crossed through, new text is underlined): 

- 64613--Chemodenervation of muscles; cervical spinal neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia).
 
-The changes [to the 64613 descriptor] are an improvement,- Busis says. -They more accurately describe the procedure and some of its indications,- but do not reflect any changes in how you should apply the code.