Neurology & Pain Management Coding Alert

According to HCFA Program Memorandum B-01-09 dated Feb. 8, 2001, HCFA has temporarily suspended version 6.3 National Correct Coding Initiative (CCI) edits that bundled 66 evaluation and management (E/M) services to many neurology procedural codes. The suspension is retroactive to Oct. 30, 2000, the effective date of the 6.3 edits. It also includes any edit pairs that were continued in version 7.0, effective through March 31, 2001. HCFA is reviewing the edits, and a number of them may be reimplemented no earlier than July 1, 2001.

A HCFA spokesman said the agency would not comment on its reason for suspending the edits. Most significant about the 6.3 edits was the bundling of E/M services with diagnostic procedures a decision that took many physicians and coders by surprise, says Barbara Cobuzzi, CPC, CHBME, president of Cash Flow Solutions Inc. in Lakewood, N.J. The changes were not adequately publicized and placed a financial burden on doctors who were suddenly receiving denials for previously covered procedures, Cobuzzi says.

The following neurology codes are no longer bundled with E/M services:

Sleep studies and electroencephalography (EEG) (95805, 95807, 95808, 95810, 95811, 95812, 95813, 95816, 95819, 95822, 95824, 95827, 95829 and 95830)

EEG monitoring and analysis, functional cortical mapping (95950, 95951, 95953, 95954, 95955, 95956, 95957, 95958 and 95961)

Neurostimulator analysis and programming (95970, 95971, 95972 and 95974)

Neurology practices should review denials received on the inclusive codes and resubmit applicable claims to their carriers (carriers will not automatically be reprocessing denied claims). Any denied E/M services meeting the criteria of significant and separately identifiable should be resubmitted.

Note: HCFAs transmittal does not specifically require coders to 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 on resubmitted claims. However, most coding experts consider this practice correct coding and recommend it.