Neurology & Pain Management Coding Alert

Proper application of -25, -51 and -59 means success for multiple procedures

If you're reporting two or more CPT codes for the same patient on the same day, chances are you'll need a modifier. Depending on whether one of the codes represents an E/M service or whether the procedures you wish to claim are bundled by NCCI, your choices boil down to -25, -51 and -59. Pair -25 With E/M Service If the neurologist performs a legitimate E/M service and another service or procedure for the same patient on the same date of service, you should append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service code.

How to use -25: A patient with carpal tunnel-like symptoms arrives for an initial consultation with the neurologist. The neurologist takes a full history, examines the patient and conducts electromyography and nerve conduction studies.

In this case, you should report the appropriate test codes (for example, 95860, Needle electromyography; one extremity with or without related paraspinal areas, and 95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), along with 99243 (Office consultation for a new or established patient ...) for the E/M service. Because you are billing the test codes and the E/M service on the same date, you should append modifier -25 to 99243.

"CMS guidelines stipulate that all procedures include an 'inherent' E/M component," says Barbara J. Cobuzzi, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a premier medical billing company in Brick, N.J.

Therefore, to differentiate the inherent E/M component of an EMG, for instance, from a truly significant and separately identifiable E/M service, you should append modifier -25. "This tells the payer that the E/M service the physician provided was above and beyond that needed simply to carry out the other services claimed," Cobuzzi says.

Separate documentation helps: To further differentiate your same-day E/M claims, you should document the E/M service on a separate sheet from the other procedures the neurologist performs on the same date.

For instance, the physician could document the history, exam and medical decision-making in the patient's chart, and record the procedure notes on a different sheet attached to the chart, says Brenda W. Messick, CPC, a coding specialist in Atlanta.

Remember, date of service matters: Suppose a patient presents early in the day for an injection (for example, 20552, Injection[s]; single or multiple trigger point[s], one or two muscle[s]) for neck pain (723.1). Later in the day, the patient begins to feel dizzy and nauseated. Fearing an adverse reaction to the injection, the patient returns to the neurologist's office. The neurologist evaluates the patient and [...]