Neurosurgery Coding Alert

There still isn't a list of accepted diagnoses for 96020

There is good news surrounding CPT's new-for-2007 code for functional brain mapping. Neurosurgery coders are delighted that the code lets you report the treatment with greater accuracy.

But you must be sure you know how to code each part of the procedure before submitting claims -- or this new code could cause a heap of denials for your practice.

To help guide you through the do's and don-ts of reporting 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report), read this expert advice on how you should use it to correctly report your neurosurgeon's services.

Physician Might Perform Mapping Before Surgery

Neurosurgeons use functional brain mapping as a noninvasive way to help predict the potential for neurological problems that tumor growths, surgical interventions or other factors might cause. Conducting the test helps the physician and patient make informed decisions concerning surgery or other treatments.

-Preoperative, noninvasive neurofunctional mapping is an alternative to direct cortical stimulation or somatosensory evoked potentials, which may be unsuccessful and be associated with visual distortion, seizure and longer surgical time,- says Neil Busis, MD, clinical associate professor in the University of Pittsburgh School of Medicine's neurology department.

-The functional brain mapping code is too new to see a list of approved diagnoses from the carriers,- adds Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.

Diagnoses that Jandroep and others believe you might see associated with functional brain mapping in the future include:

- arteriovenous malformations -- 747.x (Other congenital anomalies of circulatory system)

- epilepsy -- 345.x (Epilepsy and recurrent seizures)

- traumatic brain injury -- 854.x (Intracranial injury of other and unspecified nature)

- Parkinson's disease -- 332.x

- schizophrenia -- 295.x (Schizophrenic disorders)

- Huntington's disease -- 333.4 (Huntington's chorea).

If you-d like more details on possible diagnoses, Jandroep recommends that you check out the Web site www.neurognostics.com/fMRI_Users_Neurology&Neuropsychology.htm.  

Read the Fine Print for Better Direction

Because 96020 is a new code in a new section, CPT elaborates by including several notes to help you report the code correctly.

The first note is a general explanation of the code and when you will use it -- when your provider selects and administers neurological function tests (or language, memory, movement, etc.) with functional neuroimaging, monitoring the patient's performance and determining the test's validity relative to -separately interpreted functional magnetic resonance images.-

Note: See CPT for the complete explanation.

Other notes beneath 96020's descriptor give more details about correct reporting:

- For functional magnetic resonance imaging (fMRI) of the brain, use 70555 (Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing).

- Do not report 96020 with 96101-96103 (Psychological testing) or 96116-96120 (Neurobehavioral or neuropsychological testing).

- Do not report 96020 with 70554 (- including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration).

- Do not report codes for E/M services on the same day as 96020.

Remember 70555: CPT added 70555 for you to report with 96020. The codes work together to report MRI neurofunctional brain mapping of the patient's blood flow changes in response to tests the neurosurgeon (or other provider) administers.

The tests check the patient's motor skills, vision, language and memory. The physician completes the testing component of the procedure (96020) during the patient's MRI.

-It seems to me these are designed to be used together, but not necessarily on the same claim form,- Jandroep says. -Code 96020 is the testing code, and 70555 is the actual imaging code. It's possible that one physician does the testing procedure and another physician does the imaging procedure.-

Forget 70554: Coders should not report CPT's other relatively new code for functional MRI brain mapping (70554) with 96020.

Here's why: The codes conflict because of physician involvement. Code 70554's descriptor states, -not requiring physician or psychologist administration,- whereas 96020 states, -with test administered entirely by a physician or psychologist.- The actual services of 70554 and 96020 overlap, which is another reason you can't report them together.

Ignore other psychological tests: Code 96020 includes the psychological, neuropsychological and neurobehavioral tests represented by 96101-96103 and 96116-96120. That means you can't report any of these tests with 96020.

Nix Same-Day E/M Service Reporting

The final CPT note states you cannot report E/M services on the same day as 96020.

Sometimes a technologist or physicist -- instead of a physician or psychologist -- performs the MRI. In that case, report 70554 because it encompasses the test administration and imaging by a nonphysician.

Jandroep and other coders aren't sure why the guidelines specifically exclude E/M reporting with 96020 but say you probably wouldn't run into the situation anyway. -This seems to be a procedure that would be scheduled ahead of time,- Jandroep says. -Therefore, the physician would have already completed the E/M.-

In the rare event when your physician completes an E/M and brain-mapping test on the same day, you would only report 96020.

Final report included: The testing data usually downloads to an offline computer where your physician reviews and analyzes the patient's performance for each task and provides validity measures associated with specific brain regions. He writes a report that summarizes the patient's performance and his analysis -- but don't code it.

The last phrase of the 96020 entry is -with review of test results and report,- so don't slip up and try to code the report separately.