Neurology & Pain Management Coding Alert

Some edits point you to reporting nerve injection, others don’t.

Each new year signals new codes, new guidelines – and new Correct Coding Initiative (CCI) edits. The most recent round of edits, CCI 19.0, was effective Jan. 1, 2013, with thousands of new edits "going live." Read on for highlights of changes that could affect your neurology or pain management coding, particularly when you report needle EMG or nerve injections.

Report Anesthesia Instead of Needle EMG, Other Services

Hundreds of edit pairs list anesthesia as the correct code to report, usually justified by the explanation of "CPT^® manual or CMS manual coding instructions." For example, codes 00210-00222 (Anesthesia for intracranial procedures …) should be reported instead of a wide range of associated procedures, including:

92585 — Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive

95860 — Needle electromyography; 1 extremity with or without related paraspinal areas

95910 — Nerve conduction studies; 7-8 studies

95940 — Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure).

Many of the same secondary (column 2) codes for edit pairs carry throughout the anesthesia code section of CPT^® 2013. All of these edits that are justified through CPT^® or CMS instructions carry a modifier indicator of "0," meaning you cannot append a modifier and submit documentation to be paid for both portions of the procedure.

Claim Nerve Injections over Other Needle EMGs

From a pain management perspective, you’ll focus on reporting nerve injections or destructions instead of certain other procedures.

Example 1: Fourteen procedures are listed as Column 2 codes in edits with the following NCCI Column 1 injection groups:

Epidural injections (62310-62319)

Somatic nerve injections (64400-64484)

Injections to paravertebral spinal nerves and branches (64490-64495)

Autonomic nerve injections (64505-64530).

Report the Column 1 nerve injection instead of the Column 2 diagnostic procedures such as 95863-95866 (Needle electromyography …), new codes 95907-95913 (Nerve conduction studies …), 95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes [List separately in addition to code for primary procedure]), and G0453 (Continuous intraoperative neurophysiology monitoring, from outside the operating room [remote or nearby], per patient, [attention directed exclusively to one patient] each 15 minutes [List in addition to primary procedure]).

Pay attention: As you comb through CCI 19.0, you’ll see that although 95940 is included in the edits, associated code +95941 (Continuous intraoperative neurophysiology monitoring, from outside the operating room [remote or nearby] or for monitoring of more than one case while in the operating room, per hour [List separately in addition to code for primary procedure]) is not. "The new code 95941 is not a payable code for Medicare," explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver. "Medicare often does not include codes that they don’t cover in the CCI bundling edits."

Code +95941 carries a "1" status indicator in the Medicare Physician Fee Schedule, meaning the code is not valid for Medicare purposes and that Medicare uses another code for reporting and payment of those services. In the case of +95941, Medicare’s replacement code is G0454 (Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist).

Note: All of these edits are considered non-mutually exclusive. Some edit explanations fall under "Standards of medical/surgical practice," and others "Misuse of column two code with column one code." Once again, every edit carries a modifier indicator of "0."

Example 2: The same fourteen codes for needle EMG, nerve conduction study, and neurophysiology monitoring procedures also are Column 2 codes with the following Column 1 codes:

Destruction by neurolytic agent (64600-64640)

Sympathetic nerve destruction (64650-64681).

Check the full list of edits for all procedures included in these bundles since they’re too extensive to list individually. New code 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]), for instance, is the Column 1 code almost 150 other procedures listed as Column 2 codes.