Neurology & Pain Management Coding Alert

Plus: ‘Good news’ with retroactive edits won’t help your bottom line.

Correct Coding Initiative (CCI) edits, version 19.3, went into effect October 1 with hundreds of deleted and retroactive edits. You may want to note these edits that will affect your neurologist’s hospital care services. 

Watch for E/M Charges on Same Date as Hospital Discharge

The change: Edits bundle E/M codes for new and established patient office visits (99201-99205 for new and 99211-99215 for established) as Column 2 codes into hospital discharge services codes:

• 99238 – Hospital discharge day management; 30 minutes or less
• 99239 – … more than 30 minutes.

Remember: Codes 99238 and 99239 are used to report all services provided to a patient on the date of discharge, when that date of service is different from the initial date of inpatient status. If you’re reporting observation or inpatient hospital care on the same date as the patient’s admission or discharge, you would choose from codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date …).

“The important point is that these new bundling edits cannot be bypassed with a modifier,” says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. “If the physician performs the hospital discharge services, he or she could not bill for an office E/M service that was potentially performed later in the day.”

Avoid Celebrating Over Retroactive Changes

Many retroactive edits pertain to somatic nerve blocks 64400-+64484 (Injection, anesthetic agent …) and paravertebral spinal nerve and branch blocks 64490-+64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] …).

Only four procedures are paired with the nerve blocks in the retroactive edits:

• 20552 – Injection(s); single or multiple trigger point(s); 1 or 2 muscle(s) 
• 20553 – … 3 or more muscles
• 92012 – Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
• 92014 – … comprehensive, established patient, 1 or more visits.

Effect: A quick look shows why these retroactive edits won’t apply to neurology or pain management practices – your physicians don’t perform these ophthalmic services. Bundling these evaluations into the trigger point injections or nerve blocks won’t make a difference to your providers or change your coding.  

Be informed: Keeping up with each quarter’s edits is always good practice, even if you see that the changes won’t directly affect your coding. Visit www.cms.gov and search for Correct Coding Initiative 19.3 to see the complete file.