Urology Coding Alert

Pay attention to CCI bundles before choosing your codes.

In the Urology Coding Alert Vol. 5, No. 7 article “4 Tips Help Stimulate Your SNS Reimbursement Success” you learned how to code when your urologist performs sacral nerve stimulation (SNS) placement procedures.

Some subscribers have contacted Urology Coding Alert for clarification on when you can report testing with lead placement. Read on to get the scoop on when to report 95926 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs) along with one of the following add-on codes:

• +95940 — Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
• +95941 — Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure).

Beware of CCI Bundles

The previous article stated that if you are billing a private (non-Medicare) payer, you might be able to report 95926 and +95940/+95941 along with the 64561 (Percutaneous implantation of neurostimulator electrode array; sacral nerve [transforaminal placement] including image guidance, if performed) for the temporary lead placement or 64581 (Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement]) for the permanent lead placement.

The key: For any payers who follow the Correct Coding Initiative (CCI) edits, you will not be able to report these codes together with 64561 or 64581.

Here’s why: CCI bundles the 95926 monitoring code, and the +95940 with both temporary lead placement code 64561 and permanent lead placement code 64581. “The edits are flagged with ‘0’ in the edit modifier column, meaning that there are no circumstances under which these testing codes should be billed separately with lead placement codes 64561 and 64581,” explains Linda Holtzman, MHA, RHIA, CCS, CCS-P, CPC, CPC-H, consultant with Clarity Coding, Inc. in the Philadelphia, Penn. area.

Additionally: You can also find guidance about reporting testing codes along with the surgical procedure in the NCCI Policy Manual, Version 18.3 (revision date 1/1/13), chapter 11, L-5. In the policy guide, you will see the statement: “intraoperative neurophysiology testing (CPT^® codes 95940, 95941) should not be reported by the physician performing an operative or anesthesia procedure since it is included in the global package …the physician performing an operative procedure should not report other 90000 neurophysiology testing codes for intraoperative neurophysiology testing (e.g. …95926 …) since they are also included in the global package.”

Therefore, especially for Medicare contractors and many private payers following these CCI edits and policies you will not be able to report 95926, +95940, and +95941 with 64561 or 64581. Remember, in addition, “CCI edits and policy form a national standard and have been widely adopted by many private payers,” Holtzman says.

“While it is possible that some non-Medicare private payers will not follow the CCI edits and you would be able to report the testing codes with the lead placements and be reimbursed, it is more likely that you won’t be able to report them together because your particular payer follows CCI guidelines, which create a national standard of coding,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. “The bottom line is that you need to know your payers’ policies.”

Include Lead Testing In Placement

Beyond the CCI edits, you may not be able to report 95926 and +95940/+95941 because of guidance directly from CPT^®. “The vignette for temporary lead placement code 64561 (CPT^® Changes 2002-An Insider’s View, p.143-144) says that ‘re-testing of the temporary lead is performed to confirm appropriate responses,’” Holtzman points out. “Likewise, the vignette for permanent lead placement code 64581 says that ‘the electrode must be replaced and retested until the appropriate physiological responses are demonstrated…’  Inclusion in the vignette typically means that a step is integral, unless the vignette specifically indicates that it may be coded separately which it does not for lead testing.”

Because of these statements in the CPT^® vignette, payers may see separately reporting 95926 and +95940/+95941 along with the 64561or 64581 as unbundling of services that are integral to the main procedure.

Bottom line: As mentioned above, you need to be sure you know how your individual payers want you to report SNS placements and the associated testing and monitoring of the generators and leads.