Neurology & Pain Management Coding Alert

Replacing your coding manuals annually is one way to help Combating denials means cooperating with physicians to ensure your claims have enough documentation to support the services you've reported. In fact, CMS consistently argues that it most often rejects claims because of simple documentation issues. Here are three areas to watch for:  1. Insufficient or Missing Evidence As a coder, you can act as a second set of eyes to catch busy doctors' documentation oversights. Often, documentation can be the single most important - but overlooked - factor in the success of any claim, says Marvel J. Hammer, RN, CPC, CCS-P, CHCO, president of MJH Consulting in Denver.

Here are some basic items to look for:

Has the physician listed a chief complaint? (Signs and symptoms will suffice if there is no definitive diagnosis.)

For time-based codes, such as critical care (99291-99292), various diagnostic tests (for example, 95812, Electroencephalogram extended monitoring; 41-60 minutes) and others, has the physician specifically recorded the time he spent performing billable services?

Has the physician authenticated (signed) the medical record?

Are the physician's notes legible? Do not report a service without clear, necessary documentation. Instead, ask the physician for additional information. This may seem bothersome, but you'll save effort in the long run by avoiding rejected claims.

Example: Due to unfavorable patient reactions, the neurologist must re-adjust the parameters of a complex deep brain stimulator. The neurologist wishes to report 95978 (Electronic analysis of implanted neurostimulator pulse generator system ...; first hour) and +95979 (... each additional 30 minutes after first hour ...) for this time-consuming service. Although he records the parameters he adjusted, he fails to document the total time he spent.

Because 95978 and 95979 are time-based, the alarms should go off in your head immediately if the physician doesn't note the total time that he spent (or, even more helpful, the "start" and "stop" times). Without that kind of documentation, the claim won't stand a chance.

Solution: Go back to your neurologist and ask him to include a note in the patient record outlining the time he spent on the service.
 
The Top-10 Reasons Medicare Says 'No' You can't correct your mistakes if you don't know what you're doing wrong. Here's a recent list of the most common problems CMS sees with the claims it receives

1. No documentation of service

2. No signature or authentication

3. Always assign the same level of service (LOS)

4. Consult versus outpatient/office visit

5. Invalid codes due to old resources

6. Unbundling of procedure codes

7. Misinterpreted abbreviations

8. No chief complaint listed/reflected

9. Global fee service billed separately

10. Inappropriate or no modifier used. (Items in bold are discussed this issue. Look to next month's Neurology Coding Alert for more information on the remaining items.)

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