Neurology & Pain Management Coding Alert

Knowing what the code includes -- and doesn-t -- makes a difference CPT's new code for functional brain mapping lets you report procedures more accurately -- but be sure you know how to code each part of the procedure before submitting your claims.

Two experts weigh in on how you should use 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report) to correctly report your neurologist's services. Know When to Watch for Brain Mapping  Neurologists use functional brain mapping as a noninvasive way to help predict the potential for neurological problems that tumor growths, surgical interventions or other factors might cause. Conducting the test helps the physician and patient make informed decisions concerning surgery or other treatments.
 
-Preoperative, noninvasive neurofunctional mapping is an alternative to direct cortical stimulation or somatosensory evoked potentials, which may be unsuccessful and be associated with visual distortion, seizure and longer surgical time,- says Neil Busis, MD, clinical associate professor in the University of Pittsburgh School of Medicine's neurology department.

-The functional brain mapping code is too new to see a list of approved diagnoses from the carriers,- adds Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.

Diagnoses that Jandroep and others believe you might see associated with functional brain mapping in the future include:

- arteriovenous malformations -- 747.x (Other congenital anomalies of circulatory system)

- epilepsy -- 345.x (Epilepsy and recurrent seizures)

- traumatic brain injury -- 854.x (Intracranial injury of other and unspecified nature)

- Parkinson's disease -- 332.x

- schizophrenia -- 295.x (Schizophrenic disorders)

- Huntington's disease -- 333.4 (Huntington's chorea). If you-d like more details on possible diagnoses, Jandroep recommends that you check out the Web site www.neurognostics.com/fMRI_Users_Neurology&Neuropsychology.htm. 

Read the Fine Print for Better Direction Because 96020 is a new code in a new section, CPT elaborates by including several notes to help you report 96020 correctly.

The first note is a general explanation of the code and when you will use it -- when your provider selects and administers neurological function tests (or language, memory, movement, etc.) in association with functional neuroimaging, monitoring the patient's performance and determining the test's validity relative to -separately interpreted functional magnetic resonance images.- Note: See CPT for the complete explanation.

Other notes beneath 96020's descriptor give more details about correct reporting:

- For functional magnetic resonance imaging (fMRI), brain, use 70555.

- Do not report 96020 with 96101-96103, 96116-96120.

- Do not report 96020 with 70554.

- Do not report codes for E/M services on the same day as 96020. Remember 70555: CPT added 70555 (Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing) for you to report [...]