Orthopedic Coding Alert

Separate Services May Warrant -59

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 test was done before the surgery or after the surgery, you could use the -59 (Distinct procedural service)," she says. But you should not use a modifier to separate the services if you perform the neurological test intraoperatively.
 
"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 states, "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 soon."
 
Note: Visit the CMS Web site at www.cms.hhs.gov/physicians/cciedits/default.asp for 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.