Hint: It's not always the 337.2x series
Without proper ICD-9 coding, you cannot justify the multiple tests often required to confirm a reflex sympathetic dystrophy (RSD) diagnosis. If your neurologist suspects that a patient has RSD, you should report signs and symptoms until testing reveals a definitive diagnosis.
The following expert tips can help your practice collect for RSD treatment every time.
Code Symptoms During Testing
The most important RSD rule is that you should not code an RSD diagnosis (337.20-337.22, 337.29) until testing reveals a definitive diagnosis, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. "Stick with signs and symptoms until you are certain of the RSD diagnosis," she continues. Neurologists may find RSD particularly difficult to diagnose because the symptoms may not be present from one hour to the next. The physician must take a careful and detailed history of the possible signs.
Start with an E/M visit: The E/M visit (99201-99205 for new patients, 99211-99215 for established patients) is the first step to diagnosis. The following outlines the most common diagnoses that neurology practices see during the three RSD stages:
Stage-one symptoms: The patient has prolonged pain, sensitivity to temperature (like the cool air from an opened refrigerator) (782.0, Disturbance; temperature sense), sensitivity to light touch (782.0, Disturbance; touch), severe (usually a burning-type) pain, skin color changes (generally a loss of color so the skin appears almost white), swelling and redness (common in cases that are vascular in origin).
Stage-two symptoms: The affected area becomes blue, cold and painful. Osteoporosis (733.0x) and joint stiffness (719.5x) can develop at this stage.
Stage-three symptoms: Muscles and tendons waste away, including contracture and withering of the affected limb. For muscle wasting, report diagnoses such as 728.2 (Muscular wasting and disuse atrophy, not elsewhere classified).
Use -25 With Nerve Block and Same-Day E/M
If the patient has severe pain, the neurologist may administer a nerve block on the same day as the E/M visit to alleviate the patient's pain until he can establish a definitive diagnosis and begin treatment.
You should report the appropriate E/M code (in this case, 99203) with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended, followed by the nerve block code (64400-64484).
The -25 modifier on 99203 tells the payer that the E/M service goes above and beyond any E/M component included in the nerve block. Without modifier -25, the payer won't reimburse for the E/M and procedure separately, warns Kimberly Hodges, CPC, an office manager for a two-physician practice in Titusville, Fla.