Neurology & Pain Management Coding Alert

Under revisions to the outpatient prospective payment system (OPPS), effective Jan. 1, 2003, payment for magnetoencephalography, or MEG (95965-95967), has increased significantly, thereby allowing hospitals and other facilities sufficient reimbursement to cover the costs of the equipment, supplies and labor associated with these procedures. Neurology coders, in turn, will likely see an increase in MEG claims and should be familiar with reporting the procedures. Like EEG,Only Better MEG, also known as magnetic source imaging (MSI), is a noninvasive functional imaging technique in which weak magnetic forces associated with the electrical activity of the brain are monitored externally, says Gregory L. Barkley, MD, head of the neuromagnetism laboratory at the Henry Ford Health System in Detroit. MEG has the same range of applications as electroencephalography (EEG). Like EEG, MEG provides real-time assessment of brain activity, but it differs in several important respects. MEG records magnetic fields rather than electrical activity (as in EEG). Consequently, MEG yields far more precise source localization (within a few millimeters as opposed to a centimeter or more for EEG). In addition, MEG offers 148 recording sites four times more than EEG resulting in highly accurate mapping. Neurologists can use MEG to examine normal brain function, map brain function in the vicinity of a tumor or epileptic focus prior to surgery or radiation therapy, image epileptic foci, monitor recovery after stroke or head trauma, and study the effects of neuropharmacological agents. Like EEG, the recorded signals may be either spontaneous or stimulus-evoked, Barkley says. Payment Issues Have Delayed Widespread Use MEG is a relatively new technology for which CPTfirst added three codes in 2002:
95965 Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization)
95966 for evoked magnetic fields, single modality (e.g., sensory, motor, language, or visual cortex localization)
+95967 each additional modality (e.g., sensory, motor, language, or visual cortex localization) (list separately in addition to code for primary procedure). Despite MEG's technical advantages, inconsistent and generally inadequate reimbursement policies have delayed its widespread use. For example, under the 2002 OPPS guidelines, the facility fee for 95965, 95966 and 95967 came to only $150 not enough to justify the expense of the equipment and necessary staffing, etc. In addition, pending further research, Part B Medicare payers and some third-party payers have adopted policy decisions that deny coverage for MEG as an investigational procedure. Continued lobbying by the American Academy of Neurology (AAN) and the National Association of Epilepsy Centers, however, has resulted in increased facility fees for MEG under OPPS. Effective Jan. 1, 2003, payment for the technical portion of 95965, 95966 and 95967 rises to $2,250, $1,375 and $875 respectively (for increases of 483-1,400 percent), and therefore more Medicare [...]