Neurosurgery Coding Alert

16 testing codes bundled into scores of spinal surgery procedures  When your surgeon performs electromyography, nerve conduction studies or other neurological tests immediately before or during laminectomies or spinal injections, you are going to have to look to modifier -59 to receive payment. Failing to do so could mean a loss of valuable payments because of bundled services.
 The National Correct Coding Initiative's (NCCI) latest version (10.1), which took effect April 1, bundles 16 testing codes into more than 520 procedure codes. Look for Nerve Conduction/Spinal Injection Bundles Take note: The Column 1 (comprehensive) codes include spine surgery (22100-22855), laminectomies and other spinal procedures (63001-63746), spinal injections (64400-64530), destruction by neurolytic agent (64600-64681) and neuroplasty (64702-64727).

NCCI now bundles the following procedures into the above codes:

92585 -- Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
95822 -- Electroencephalogram; recording in coma or sleep only
Needle electromyography (EMG) (95860-95861 and 95867-95868)
Nerve conduction, amplitude and latency/velocity studies (95900 and 95904)
Evoked potentials and reflex tests (95925-95937). Apply -59 for Separate Services Tip: You can use a modifier to separate the new bundled services if your documentation demonstrates that the services were distinct from one another, says Barbara Cobuzzi, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a medical billing company in Brick, N.J. "If the surgeon performed the test before the surgery or after the surgery, you could use the -59 (Distinct procedural service)," she says.

Warning: You should not use a modifier to separate the services if you perform the neurological test intra-operatively. These are exactly the circumstances the NCCI edits are meant to address.

"Some of these bundle combinations will be a big surprise to medical practices," says Heather Corcoran, coding manager at CGH Billing Services, a medical reimbursement consulting firm in Louisville, Ky. "The new edit bundling EMGs and nerve conduction studies into the chemodenervation codes seems to go against what some Medicare policies currently state." Keep Up With Local Policies Example: National Heritage Insurance Company, a Part B carrier for five states, publishes a policy that says, "There may be patients who require electromyography in order to determine the proper injection site(s) for the use of medications such as botulinum toxin or other agents. The ICD-9-CM code 781.99 (Other symptoms involving nervous and musculoskeletal systems) should be used in these situations."

"Because this carrier specifically says it's OK to bill EMG if you need to pinpoint a Botox injection (64612-64614, 64620) site, this type of scenario may warrant modifier -59 to separate the edits," Corcoran says. "It's too soon to tell, though, so I would recommend keeping an eye on your local policy to determine whether new EMG and injection regulations are issued [...]