Neurology & Pain Management Coding Alert

Take care not to report codes included in services you've already claimed

Medicare payers complain that they consistently see the same coding errors time after time. Here's your chance to learn from you own (and everyone else's) mistakes: A quick review of these three coding basics can go a long way toward protecting your practice's reimbursement.

Learn more: This feature is the second in a two-part series on the top-10 reasons for Medicare claims rejections. For additional information, refer to "Avoid the Most Common Reason CMS Denies Your Claim," Neurology Coding Alert, September 2005. 1. Prevent Unbundling Anytime you report more than one CPT code on a claim form, you must consider that one or more of the services you are reporting could be an included component of another, more extensive procedure that you've also claimed.

Reporting an included service separately is called "unbundling," and it's one of the most common problems with Medicare claims, according to CMS.

Example: The neurologist conducts a nerve conduction study without F-waves on the ulnar nerve (95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study). Realizing he requires more data, he performs NCS on the same nerve a second time, but with F-waves (95903, ... motor, with F-wave study). On seeing the neurologist's documentation of nerve conduction with and without F-wave, the coder reports separate units of 95900 and 95903.

Here's the mistake: The National Correct Coding Initiative bundles 95900 to 95903 for tests on the same nerve. Therefore, in this case the coder should have reported only the more extensive procedure (95903).

Solution: Always keep an updated version of the NCCI nearby and refer to it regularly.

Free resource: You can access the NCCI edits without cost at the CMS Web site http://cms.hhs.gov/physicians/cciedits/default.asp, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. The same Web page also includes links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.

CPT parenthetical notes matter, too: For instance, pain pump codes 64416, 64446, 64448 and 64449 include daily drug management as reported by 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration), as outlined elsewhere in this issue ("Continuous Infusion Codes Are the Way to Go for Your Pain Pump Claims,"). If you fail to read the parenthetical note in CPT following the pain pump code descriptors, you could easily - but incorrectly - report 01996 in addition to 64416, 64446, 64448 or 64449. 2. Avoid Modifier Mishaps Learning proper application of modifiers is crucial to successful coding. In particular, Medicare [...]