Neurology & Pain Management Coding Alert

This expert checklist gets you from reviewer to reimbursement with no fuss

Reporting unlisted procedures is more than a hassle--it requires extra time and work, sometimes for a minimal payoff, but you can streamline your efforts using the following tips.

Scenario: Your neurologist performs electrosleep therapy. You go to find a CPT code to represent this procedure, but you can't locate one. You-ll likely have to report 95999 (Unlisted neurological or neuromuscular diagnostic procedure).

Take the hassle out of the process by following this plan for better unlisted-procedure claims, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and AAPC National Advisory Board president.

1. Offer a detailed description of the procedure performed. Describe what a QST is in layman's terms--your reviewer may not be familiar with neurology.

Example: You can describe the procedure like this: -Using electrodes placed externally on the patient's head, the neurologist administered short-duration, low-amplitude pulses of direct current to the patient's brain.-

2. Include copies of articles in medical journals supporting the reasonableness of the procedure, such as clinical trials and medical indications.

3. Don't forget documentation of medical necessity to back up the decision to perform the procedure. For instance, you can include details such as -to treat chronic insomnia that has not responded to other treatments- to reinforce medical necessity.

4. Explain the time, effort and equipment required to perform the procedure, both to help the reviewer understand the procedure and to support the amount of reimbursement you request.

5. Remember to submit the patient's indications--diagnosis, chief complaint, presenting signs and symptoms, and any concurrent problems the patient has that require treatment or management.

6. Describe the patient's follow-up care and prognosis.

7. Relate the procedure performed to an existing procedure as support for reimbursement. And explain how your procedure differs to show why you didn't choose the existing code, says Heather Corcoran, manager at CGH Billing Services in Louisville, Ky. Basing your fee on a similar procedure is helpful in claims processing but not mandatory.

For the scenario above, you might request reimbursement at a level similar to sensory-evoked potential studies (95925-95927).

 8. Never underestimate the power of demonstrating cost savings from the procedure you chose. If you can illustrate how your procedure will cost the payer less in the long run than the typical course of treatment, your payer should be happy to accept your unlisted procedure.