ICD-9 2011 Update: Improve Your Seizure and Cognitive Testing Coding With New ICD-9 Codes   (June 2010)

But you should keep using 724.3 for spinal stenosis.
You’re likely holding your breath in anticipation of the numerous changes expected with ICD-10. But don’t overlook the coding changes in ICD-9 2011 that may affect how your neurology practice uses cognition codes later this year. Stay ahead of the curve with this preview of new diagnosis codes.
724.03 Puts More Detail into EMG Testing
The ICD-9 2011 changes expand disease subcategories to provide more specific descriptions. New diagnosis [...]

Coding Quiz: Pinpoint the Correct CPT and HCPCS Codes and Avoid Denials   (June 2010)

Remember the one code that can help your pre-configured NCS billing.
January brought some changes to the CPT and HCPCS codes that may be getting on your nerves. Take this three-part neurology coding challenge and give your worries a rest.
Test yourself: Of the most notable changes so far this year, chemodenervation is high on the list, with headache-inducing bundling edits. Plus, if your neurologist uses a pre-configured nerve conduction study (NCS) as the basis for a [...]

You Be the Coder: Counting Nerve Conduction Test Per Limb Will Bring Denials   (June 2010)

Question: I coded my neurologist’s diagnostic testing recently that included nerve conduction studies, an EMG, plus H-reflex testing. The neurologist’s final diagnosis was S1 radiculopathy (723.4). I billed all of the appropriate codes, plus an E/M code with modifier 25 in the following sequence:99213-2595903-LT x 295903-RT x 295904-LT95904-RT95934-LT95934-RT95861.
The patient’s carrier (Medicare) denied a lot of the diagnostic studies. Why didn’t we get paid for the full services provided?
New Jersey Subscriber
Answer: When your neurologist [...]

Modifiers 101: Proving Separate E/M Services Makes for Modifier 25 Success   (June 2010)

Avoid overusing this modifier and soliciting an audit with four tips.
If you find yourself especially overwhelmed and confused by modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), you’re not alone. Luckily, you can use these four criteria to determine whether modifier 25 is right for your neurology coding assignment.
1. Modifier 25 is for E/M Only
You can only consider reporting modifier [...]

Reader Questions: Patient Must Be Asleep During EEG to Report 95819   (June 2010)

Question: My neurologist administered an EEG that lasted for an hour. The notes from the encounter say that the patient was drowsy, but didn’t actually fall asleep during the test. I’m not sure now how to interpret that. What’s the correct code for this situation?
Wisconsin Subscriber
Answer: When a neurologist documents that a patient did not fall asleep during an Electroencephalogram (EEG) exam, you should submit 95816 (Electroencephalogram [EEG]; including recording awake and drowsy). Coding an EEG [...]

Reader Questions: Patient Becomes ’Established’ After First Visit   (June 2010)

Question: A patient came to our office and saw one neurologist, but when the patient came back for a follow-up he saw a different neurologist who ended up taking over the patient’s case. The two physicians have different provider numbers and tax ID numbers. Their only connection is that they work out of the same hospital and “cover” for one another if one is out of town, which is what happened here. My guess is [...]

Reader Questions: Intractable Seizure Dx Disappears After Surgery   (June 2010)

Question: Our practice recently saw a patient who had been having intractable seizures. The patient was on medication, but his symptoms were not responding to it, so my neurologist suggested surgery. The surgery worked and the patient no longer requires the medication. We have been using a diagnosis for intractable seizure (345.11). Should we still be using that code?
Georgia Subscriber
Answer: You may have been using 345.11 (Generalized convulsive epilepsy with intractable epilepsy) since the first [...]

Reader Questions: Remember Not to Use Consult Codes With Medicare Rules   (June 2010)

Question: A neurologist in our practice was called into a hospital for a consultation on a Medicaid patient. We billed 99254 with place of service code 21. The claim was denied. I’m new to neurology coding, so I’m not sure what we did wrong. Was the POS code wrong?
Florida Subscriber
Answer: No, your place of service (POS) code of 21 (Inpatient hospital) is not a factor in this denial. The reason your claim was denied was [...]

Reader Questions: Avoid Denials for False Duplicate Codes   (June 2010)

Question: Our practice provides sleep lab services, but for business accounting reasons, we need to separate the professional and technical components of the sleep lab services. So when we bill two line items, we’re using the same procedure codes for both. Even though we’ll append modifier TC or 26, we’ve been getting denied for duplicate services. What’s wrong with our process?
Ohio Subscriber
Answer: The problem could be that your payer is interpreting this as an attempt [...]

Muscle Testing: Use Caution With Separate Procedures on Muscle Tests   (May 2010)

But multiple Dx codes can still give you options.
Think you can only report one range-of-motion (ROM) code when your neurologist tests multiple extremities? Think again, because the answer isn’t quite so clear cut.
Find out the truth behind using 95831 (Muscle testing, manual [separate procedure] with report; extremity [excluding hand] or trunk) using these expert tips – and stop missing out on the reimbursement you deserve.
Manual Muscle Test Means 95831
Abnormalities in the human nervous system can often [...]