You Be the Coder: Neurological Eye Treatments (September 2001)
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Is there a code for a Botox injection used for the eyes? Utah Subscriber
Answer: Two common uses in neurology for Botox (J0585) involving the eye are the treatment of blepharospasm (333.81), the uncontrollable contracting of eyelid muscles, and strabismus (378.xx), misalignment of the eyes. There is a code for chemodenervation of the eye – 67345 (chemodenervation [...]
Reminder: Resubmit Same-Day E/M, Diagnostic Test Claims by Oct. 1 (September 2001)
In October 2000, version 6.3 of the national Correct Coding Initiative (CCI) added more than 50,000 edits bundling E/M services to diagnostic tests performed on the same day. To receive separate payment, providers were instructed to attach modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to any E/M code filed on the same date of service as a diagnostic test. [...]
Reader Question: Reporting 95925-95926 (September 2001)
Question: Using a dermatome-specific procedure, we evaluate eight to 10 nerves on the lower extremities and 12 nerves on the upper extremities. The insurer has asked that we code this by units, but CPT includes no such codes. How can we code to comply with the insurers requirements?New Jersey Subscriber
Answer: Only one unit of 95925 (short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in [...]
Reader Question: Bilateral H-Reflex (September 2001)
Question: When coding for bilateral H-reflex studies in the hospital, should I report 95934-26 and 95934-26-50, or only 95934-50? Virginia Subscriber Answer: When coding for the professional service only, report 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle) with modifiers -26 (professional component) and -50 (bilateral procedure) appended: 95934-26-50. Code 95934 describes noninvasive H-reflex studies involving assessment of the gastrocnemius/soleus muscle (in the calf). Testing of other muscles may be reported using 95936 (… record [...]
Reader Question: Transcranial Dopplers With Carotid Ultrasounds (September 2001)
Question: We have been receiving denials from Medicare when we bill transcranial dopplers with carotid ultrasounds. Is this correct?Missouri Subscriber
Answer: Yes, this is correct. According to Medicare, it is not medically necessary to perform more than one type of physiological study in the same anatomic area. Cerebrovascular arterial studies (93880-93888) are used to evaluate vascular blood flow in relation to blockage. A duplex scan includes a real-time scan. Therefore, billing for both a duplex scan and [...]
Reader Question: Physician Supervision Requirements (September 2001)
Question: I am still confused by the new supervision requirements for electrodiagnostic studies. We have an RN who performs the technical component of codes 95900, 95903 and 95904. She was trained by our neurologist but has no formal training or certification. Can she perform these studies? And if so, what level of supervision is required? Indiana Subscriber Answer: According to CMS Memorandum B-01-28 (Physician Supervision of Diagnostic Tests, change request 850), dated April 19, 2001, and [...]
Reader Question: Greater Occipital Neuralgia (September 2001)
Question: Our neurologist often uses the diagnosis greater occipital neuralgia, but I can find no mention of this in ICD-9. Which code applies?California Subscriber
Answer: The most commonly accepted ICD-9 code for greater occipital neuralgia is 729.2 (neuralgia, neuritis, and radiculitis, unspecified). Be cautious, however, because the correct diagnosis may be tendonitis (726.90, enthesopathy of unspecified site). Injection of the tendon would be reported 20550 (injection, tendon sheath, ligament, trigger points or ganglion cyst). Use 64405 [...]
Insert: Follow E/M Guidelines To Assign the Appropriate Consult Codes (September 2001)
Consultation codes are chosen using the same criteria as other E/M codes. With the exception of the follow-up codes 99261-99263 – which apply only to previously seen patients – consult codes (99241-99255 and 99271-99275) may be used for both new and established patients. All of the three key areas of history, examination and medical decision-making (MDM) must meet or exceed the requirements of the level chosen. History may be either problem focused, expanded problem focused, detailed or comprehensive, [...]
Medicare Carriers Instructed to Accept V Codes for Consults (August 2001)
The Centers for Medicare and Medicaid (CMS, formerly HCFA) has instructed all local Medicare carriers to accept V codes for preoperative clearance. Until now, many carriers have routinely denied reimbursement for preoperative consults by neurologists and other specialists. The announcement singles out four preoperative clearance ICD-9 codes. These are:
V72.81 (preoperative cardiovascular examination);
V72.82 (preoperative respiratory examination);
V72.83 (other specified preoperative examination);
V72.84 (preoperative examination, unspecified)
The clarification, which revises section 15047 of the Medicare Carriers Manual (MCM), states that [...]
