Neurology & Pain Management Coding Alert

Stay sharp on some of coding's more puzzling answers. How did you do? Check your answers, and take note of any problem areas. With or Without Myelopathy Makes a Difference. Solution 1: A. You can rely on 721.0 (Cervical spondylosis without myelopathy) for cervical spondylosis as well as cervical arthritis, cervical osteoarthritis, and cervical spondylarthritis. Look to 721.1 (Cervical spondylosis with myelopathy) if your provider includes documentation of myelopathy, which is damage to the spinal cord from compression or another condition. Watch Out For Changes in 2009 Solution 2: B. As tempting as it might be to choose answer A, the most likely culprit in this example is the code combination. More than likely your physician marked the CPT code, 96413, on the charge ticket in error. An IV steroid infusion would be considered a therapeutic infusion as the medication does not meet the CPT criteria for chemotherapy administration. You can't report +90766 (Intravenous infusion ... each additional hour) without one of the accepted "initial hour" CPT codes, either 90765 (... initial, up to 1 hour) or +90767 (... additional sequential infusion, up to 1 hour). Use 90766 when there are additional hours of non-chemotherapy infusion, and report it only with 90765 or 90767. Take note: Remember the code changes for 2009. Codes 90765-7 have been deleted for 2009; use codes 96365-7 instead starting Jan. 1. Q Code Changed to J in 2008 Solution 3: True. The correct code for the Tysabri drug is J2323 (Injection, natalizumab, per 1 mg). The generic name for Tysabri is natalizumab. HCPCS 2008 replaced Tysabri's temporary Q code with this J code, going into effect on Jan. 1, 2008. FYI: Typically, the patient receives the drug via intravenous infusion every four weeks in either the inpatient or outpatient setting. Code the infusions with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and possibly the add-on code +96415
(... each additional hour [List separately in addition to code for primary procedure]), if appropriate. While 96413 and 96415 specify "chemotherapy administration," these codes also apply to infusions of monoclonal antibody agents and other biologic response modifiers, and Tysabri falls into this category. 72275 Includes 77003 Solution 4: True. You may report 72275 (Epidurography, radiological supervision and interpretation) only if the physician performs the separate diagnostic study, including the permanent radiologic images of the epidural space, and documents the diagnostic interpretation in a written report. CPT states that 72275 includes 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction), so you would not report [...]