Neurology Coding - code pulmonology

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I currently code pulmonology and will be taking over neurology coding soon. I have never done any neurology coding before. I will also be doing the billing for neurology as well. Can anyone give me any information about neurology coding and billing that will help me transition faster? Any codes and procedures that are commonly used? Any information is greatly appreciated. Thank you very much!:)
 

SLITTLES

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I have been billing Neurology for 4 years now, it is definitely not a hard specialty to learn. It depends on what services the physician will provide.

One of the Neurologist I work with only see headache patients and the other does Botox, Epidurals, EMG/NCS, nerve blocks, etc.

It's kind of hard to just break down everything, however if you ever have a question, feel free to send me a private message or email me.
 

LJAHODA

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Neurology Billing problem

Hi,
I do medical billing for the Neurology department at The Hospital for Special Surgery in Manhattan. I haven't seen anyone write about the same issue I am having. We are billing for IOM code 95920 billed with 95938(Evoked Potentials). Medicare will not pay for the IOM 95920 as they are saying 95938 is not a qualified code. AMA in the CPT book has put in their guidelines under to heading of Intraoperative Neurophysiology 95920 to used Evoked Potentials codes 95925 -95937. Evoked Potential code 95938 (upper and lower limbs) is a new code for 2012 which replaces 95925-upper limbs and 95926 lower limbs and is out of numerical sequence listed just below 95925/95926. Since this is "not" listed in the guidelines our IOM 95920 is not getting paid (this is an add on code) Is anyone else having this problem? I have done a mass appeal to Medicare but they still will not pay. Thank you Laurie
 

charissesimone

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RE: MediCare only pays for "Medically necessary"

RE: Neurology Billing problem

MediCare only pays for medically necessary. If it's considered an cosmetic procedure or not necessary for the patient to receive that type of care then the claim will get denied. Also it could become RAC or OIG target.
 
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charissesimone

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RE: Neurology Billing problem

Also add on codes per MediCare guidelines can't be used on "Principal Outpatient Procedures. CPT codes must have a Principal Code followed by add on codes(+). Also make sure the CPT codes is not already bundled into that type of service orit will pop up in the encoder as an edit. Modifier 59 can override these edit but it still has to be considered medically necessary with the proper diagnosis in which the procedure is related to.
 

JENNETT89

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I have been billing Neurology for 4 years now, it is definitely not a hard specialty to learn. It depends on what services the physician will provide.

One of the Neurologist I work with only see headache patients and the other does Botox, Epidurals, EMG/NCS, nerve blocks, etc.

It's kind of hard to just break down everything, however if you ever have a question, feel free to send me a private message or email me.
Slittles,
what can you share about neurology/pain management for drug screening tests? & epidural injections with contrast? & last one, emg/ncs-are teh graphsa a required component of documentation?
thank you
Jeannette R.
 

pertalad

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Slittles,

When coding EEG's basic 95816 and the neurologist does a single channel ekg. Is that included in 95816?

Thanks, pertalad
 
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2013 EMG Code Changes

Hi, I see we have some experienced Neurology Billing Professionals here, I'm hoping to glean some knowledge from you if possible! :) In response to the 2013 coding changes for EMG/NCV, I am looking to reprice the NCV portion of my EMG studies and have worked with the Medicare fee schedule. But, I am looking for instruction as to how best to set my doctor's prices for his commercial insurance billing. I am looking to bill "fair and customary" prices. I would also like to compare prices with other local Neurologists (local to southeast Wisconsin). Any help would be appreciated. Thank you so much! Michele
 

cgillies

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Hi,
I do medical billing for the Neurology department at The Hospital for Special Surgery in Manhattan. I haven't seen anyone write about the same issue I am having. We are billing for IOM code 95920 billed with 95938(Evoked Potentials). Medicare will not pay for the IOM 95920 as they are saying 95938 is not a qualified code. AMA in the CPT book has put in their guidelines under to heading of Intraoperative Neurophysiology 95920 to used Evoked Potentials codes 95925 -95937. Evoked Potential code 95938 (upper and lower limbs) is a new code for 2012 which replaces 95925-upper limbs and 95926 lower limbs and is out of numerical sequence listed just below 95925/95926. Since this is "not" listed in the guidelines our IOM 95920 is not getting paid (this is an add on code) Is anyone else having this problem? I have done a mass appeal to Medicare but they still will not pay. Thank you Laurie
Have you heard or gotten anywhere on this problem? We are still having issues with it. Please let me know if you have gotten anywhere on it.
Cheryl
 
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