Neurology & Pain Management Coding Alert

CPT 2002 was made available in November 2001. In an early release of new and revised codes, the AMA has a preview of changes for the upcoming year. Changes affecting neurology are few, and generally serve only to clarify or narrow previous definitions. In most cases, the revised descriptors do not affect how the codes are applied.
 
Although only time will tell how CMS and private payers will respond to the revisions, you should begin preparing now for the changes. CPT 2002 is officially effective Jan. 1, 2002, but not all payers adopt changes uniformly. Check with your carrier before billing any of the revised codes outlined below.
  
Lumbar Puncture
The descriptor for 62272 has a slight revision (new text has been bolded):

62272 spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter).
 
Previously, the descriptor less specifically indicated "for drainage of spinal fluid."
Neuroimaging
For greater clarity, 78615 now specifies "vascular flow" rather than "blood flow."

78615 cerebral vascular flow.
 
Likewise, neuroimaging code 78560 drops the abbreviation "CSF" in favor of  "cerebrospinal," without affecting use of the code.
 
78650 cerebrospinal fluid leakage detection and localization.
Therapeutic or Diagnostic Infusions
In a change similar to that affecting 78650, infusion code 90780 drops the abbreviation "IV" for "intravenous."
 
90780 intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour.
 
This change does not alter application of the code, and physicians should continue to assign 90780 with caution. Specifically, documentation of physician presence during the infusion is required, says Carol Pohlig, BSN, RN, CPC, who works in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. To meet the requirement for "direct" supervision, the physician must be present in the office suite (although not necessarily in the same room) and immediately available to instruct or assist.
Nerve Conduction Studies
The phrase "or mixed" has been eliminated from the descriptor for nerve conduction study (NCS) code 95904:
 
95904 nerve conduction, amplitude and latency/velocity study, each nerve; sensory.
 
Of all the changes, this is perhaps the most important for neurologists. "This is a huge issue, even though the wording change seems slight," says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology at the University of Pittsburgh School of Medicine. "Because of the wording change, improper bundling of motor with sensory nerve conduction studies will no longer be as likely to occur. This will dramatically decrease the hassle inflicted on physicians doing EMG/NCS under the current definitions."
 
Until now, some insurers (and providers) did not understand what constituted a [...]