Wiki Canalith repositioning procedure

[deborahcook4040]

Medicare states that this procedure (95992) is supposed to be bundled with the E/M codes if done by a physician and billed as Neuromuscular Reeducation (97112) if done by a physical therapist (they don't recognize 95992 as a billable code). The AMA assignes a relative value of about 20 minutes of intra-service time for this procedure. Does anyone know if that accounts for having to do the procedure more than once? I'm thinking we may need to bill for prolonged E/M when my Neurologist does this procedure, but I'm not sure what to tell him he needs to correct on his dictation. Would recording time spent with the patient be enough, or do you think Medicare would deny as NMN? I don't want to have him dictate the whole procedure out when medicare doesn't recognize it as reimburseable anyway, but I want to make sure Medicare can't deny the prolonged services codes for incomplete documentation, either.

Any thoughts?

 

[j.berkshire]

I suggest it would be appropriate to bill the documented E&M plus prolonged care codes to account for the time to perform this procedure and the E&M. It is bundled now, but the 2011 proposed physician fee schedule unbundles the Eppley from the E&M service. For prolonged care the physician must document start and stop times for Medicare; not only the total time.