Coding Tips: Get Your Routine And Extended EEG Coding Into Gear With These Pointers   (November 2011)

Precise timing of EEG monitoring is the key, frequency is not important.
When reporting EEG recording, the most crucial factor is to time the procedure. If your physician uses advanced techniques, video and digital recordings, you may be faced with additional coding challenges for these services. Read on to equip yourself on how to precisely time the procedure and code the routine, extended, and special monitoring.
Look For How Long the Diagnostic Study Lasted
When reporting EEG, [...]

ICD-10 Update: Regions Are Important To Report Radiculopathy   (November 2011)

Single ICD-9 code spans to eight codes in ICD-10.
Radiculopathy is site-specific for spinal regions in ICD-10. To ensure that your provider will be ready when the Oct. 1, 2013 deadline hits, you can reinforce the need for specific region notes in the documentation. Make sure your provider mentions the involvement of one or more of the specific spinal regions.
Review Anatomical Locations
The spine is divided into five regions, namely the cervical, thoracic, lumbar, sacral, and coccygeal [...]

You Be the Coder: Marcaine Anesthetic Before Injection Usually Means No Pay   (November 2011)

Question:
We’ve had increasing problems billing and being paid for the medications we use for trigger point and nerve block injections. We bill J1094 for Dexamethasone 4 mg, S0020 for Marcaine 0.5% and J2010 for Lidocaine 2%. We never get paid for the Marcaine and rarely get paid for the Dexamethasone. Are there other drugs we should be using? Or are we using the correct drugs with the wrong codes?80.09. What should I change when we [...]

Reader Questions: Focus on Start Date for Overnight Sleep Study Billing   (November 2011)

Question:
A patient came to our office for a sleep study at 9 p.m. on Monday; the study ended the next day at 7 a.m. The neurologist wrote the report on a different day. We split the bill between professional and technical components. Since we have three different dates (start, end, and report), what date of service should we assign for the technical and professional bills?
Illinois Subscriber
Answer:
If your neurologist conducts a sleep study overnight, [...]

Reader Questions: Report 77003 With 27096 Now, But Not In 2012   (November 2011)

Question:
Our pain management specialist often administers bilateral sacroiliac injections. I’m new to pain management coding but am not sure our previous biller reported the service correctly. What is the correct way to submit bilateral injections with fluoroscopic guidance?
Mississippi Subscriber
Answer:
Begin with 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) for the SI injection. Because your specialist administered bilateral injections, check the payer’s policy regarding how to report the service. Some payers require you to append [...]

Reader Questions: Extra Time Can Be Part of 99241-99245 Consult Codes   (November 2011)

Question:
Our neurologist provides pre-op consultations for requesting surgeons. He completed the consult with a recent patient, but also spent quite a bit of time discussing and focusing on some of the patient’s health issues. Can we bill that separately as education or counseling (or a problem-focused visit), or is it included in the consult?
Illinois Subscriber
Answer:
Anything discussed as part of a consult is included in that encounter’s consultation code. That’s one difference between consultations [...]

Reader Questions: Yes, You Can List Multiple PQRS Measures   (November 2011)

Question:
Can we report more than one PQRS code measure on the same claim?
West Virginia Subscriber
Answer:
Yes. You aren’t limited to reporting just one Physician Quality Reporting System (PQRS) code per visit.
“EPs [eligible professionals] may submit multiple codes for more than one measure on a single claim,” CMS states in its PQRS Implementation Guide. “Multiple CPT® Category II and/or G-codes for multiple measures that are applicable to a patient visit can be reported on the same [...]

Reader Questions: Point to 64405 for GON Blocks   (November 2011)

Question:
How should I code a left GON block?
Washington Subscriber
Answer:
Use 64405 (Injection, anesthetic agent; greater occipital nerve) and modifier LT (Left) to report the unilateral greater occipital nerve (GON) block. Neurologists often use occipital nerve blocks for patients with 723.8 (Occipital neuralgia). This condition produces an aching, burning, or throbbing pain, or a tingling or numbness, along the back of the head. The GON originates from the C2 spinal nerve and provides sensory innervation to [...]

CCI Update: New CCI Edits Reverse ‘No-Go’ Status of Injections With Some Vascular Procedures   (October 2011)

Hint: Visit ‘deleted edits’ section for updates to paravertebral facet joint injections. The latest edition of Correct Coding Initiative (CCI) edits, effective Oct. 1, holds some nice surprises for neurology and pain management coders. Instead of being saddled with additional edits that restrict your claims filing, most pairs related to neurology or pain management actually fall under the “deleted edits” category. “For the terminated pairs, 218 were retroactively terminated back to the last quarter release [...]

Neurology: Don’t Miss Indicator Change from ‘0’ to ‘2’ for 95928 and 95929   (October 2011)

Your pay won’t change, but modifier shifts to better reflect procedure.If you code for motor evoked potential testing, you’ll need to be up to speed on a bilateral modifier change that could change your reporting. New modifier indicators are in effect as of Oct. 1, 2011 for these procedures, thanks to Medicare Physician Fee Schedule updates. Prepare for ‘0′ to ‘2′ Modifier Status The modifier indicator change affects codes 95928 (Central motor evoked potential study [...]