Neurology & Pain Management Coding Alert

Epley maneuver and other new codes offer more places to get reimbursement. The time to implement the annual CPT updates is almost here already. Remember how reporting canalith repositioning used to be a cross-your-fingers procedure? Not anymore. Gear up for 2009 with a crash course in changes most likely to affectyour neurologist's practice. Epley Makes Up One of the Biggest Neuro Changes Two of the biggest additions to neuro-specific codes include canalith repositioning (aka the Epley maneuver) and actigraphy, a sleep testing code. Here's what you need to know about Epley. - 95992 -- Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day In 2008 and before, physicians often included Epley work in an E/M code reported that day, or reported Epley as 95999 (Unlisted neurological or neuromuscular diagnostic procedure) or 92700 (Unlisted otorhinolaryngological service or procedure),says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, from MJH Consulting in Denver. These codes were recommended by some payers as the best for the Epley, even though they are unlisted procedure codes. Relative value units (RVUs) for 95992 are 1.13 for non-facility, and 1.02 for facility in 2009. But the new CPT code for the Canalith procedure will carry a "B" or bundled status indicator for Medicare, Hammer adds.-"Even though there are established RVUs for the new code, Medicare won't be allowing separate payment for the service."-According to CMS, physicians-should continue to report this service as included in their E/M services. "It will be up in the air for commercial payers as to how or if they will separately process this new CPT code for payment," Hammer says. Heads up: There has been a valid HCPCS code for canalith repositioning for some years, S9092 (Canalith repositioning, per visit), but Medicare does not recognize S codes. While most Blue Cross/Blue Shield and some additional commercial payers recognize S codes, such HCPCS codes have no established relative value units. New Sleep Study Tool: Actigraphy -95803 -- Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording) What it is: Actigraphy uses a motion detection sensor that, like a wrist watch, is typically worn on the nondominant wrist, says Sam Fleishman, MD, medical director of the Sleep Center in Cape Fear Valley, N.C. "By monitoring movements one can get a measure of an individual's rest and activity periods and thus get a sense of one's sleep/wake patterns over time," Fleishman says. Patients wear the actigraph for up to two weeks. The information is downloaded and analyzed with a statistical and graphic printout, and correlated with the patient's subjective report with a sleep diary. What it's worth to you: According to CMS, carriers will price this code, establishing RVUs [...]