Neurology & Pain Management Coding Alert

Know when and how to rely on this tool -- but don't expect to always get paid When your neurologist performs a service Medicare doesn't usually reimburse, don't assume it's an automatic write-off. Keep an eye out for these potential roadblocks and file an advance beneficiary notice (ABN) up-front to switch the odds in your favor. What it is: An ABN is a written notice that informs the beneficiary (that is, the patient) that Medicare might not cover a particular service or procedure. Signing the waiver shows that the patient acknowledges he may have to pay for the procedure or service if Medicare does not -- if you document his treatment correctly, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.
Why Won't Medicare Pay? If Medicare doesn't pay for a service your physician offers, the reason usually falls into one of two categories: procedures that have exceeded Medicare's frequency guidelines and procedures that Medicare doesn't ever reimburse. Over-the-limit procedures: Medicare only allows for a finite number of certain procedures per patient per time period. Nerve conduction studies (NCS) are a prime example of this for neurology practices. You report NCS with the appropriate choice from 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), 95903 (- motor, with F-wave study) or 95904 (- sensory). CPT's Appendix J -- and your local Medicare carrier's guidelines -- will help you keep within the allowed boundaries for NCS. Never-reimbursed procedures: Also, there are some procedures that Medicare doesn't ever cover, such as administering Botox for sialorrhea (527.7), says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside. In these cases, you won't need a signed notification unless a secondary insurer is willing to pay for the service.
Why Try an ABN?
Your physician has two main reasons to obtain a signed ABN from patients in certain circumstances: to ensure reimbursement for services provided but deemed not covered by Medicare, and to reduce the risk of compliance implications associated with ABNs. When you present patients with an ABN (and explain it to them), you help patients decide whether they want to proceed with a service even though they might have to pay for it. A signed ABN ensures that your neurologist will receive payment directly from the patient if Medicare refuses to pay. Best reason: Without a valid ABN, you cannot hold a Medicare patient responsible for the denied charges, leaving the bill in your physician's lap.
What Should an ABN Contain? A valid ABN must be approved by Medicare and must include: patient name and Medicare [...]