Neurology & Pain Management Coding Alert

Question: Does Medicare assign a global period for unlisted-procedure codes? For instance, if the neurologist performs qualitative sensory testing (QST) and we report 95999, can we charge for a follow-up office visit 10 days later?


Pennsylvania Subscriber



Answer: National Medicare policy, as reflected in the Physician Fee Schedule database, does not establish a formal global period for unlisted-procedure codes, such as 95999 (Unlisted neurological or neuromuscular diagnostic procedure). Rather, national Medicare assigns such codes a "YYY" global period, meaning that the individual carrier "is to determine whether the global concept applies and establishes postoperative period, if appropriate, at time of pricing," according to CMS guidelines.

In other words, the payer holds all the cards and can determine whether and what kind of global period to impose when you submit an unlisted-procedure code.

In most cases, the payer will assign an "XXX" global period for diagnostic procedures such as QST - which means the procedure includes no global period. You can attempt to influence the payer's decision by noting the global period for similar procedures when submitting your claim (for instance, QST closely resembles motor and sensory nerve conduction velocity tests [95900-95904], which include an XXX global period).
 
If the payer does institute a global period, however, you should not report follow-up visits during that time as separate services.
 
Don't make assumptions about your payer's rules: Get your payer's guidelines in writing and follow them consistently. Like everything else involving unlisted- procedure claims, this will require extra effort, but it will also ensure the best reimbursement and prevent you from facing fraudulent-coding charges.