How To Write A Neurology Code
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1 February 2013 Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS
2 2 Payment Basics Agenda Code & Payment Changes 2013 Changes to Nerve Conduction Studies Physician Rate Changes Hospital/ Technical Rate Changes EMG Add-on Codes Other Changes
3 3 Medicare Paid under APCs Payment Diagnostic neurology codes are mostly Status Indicator S Few are Status N- packaged Split-bill for professional- Use Modifier 26 where applicable HCPCS dept sub dept Mod Short Description Carrier Locality 99 POS NEURODX EMG Motor&/sens 1-2 nrv cndj tst $ NEURODX EMG 26 Motor&/sens 1-2 nrv cndj tst $ NEURODX EMG TC Motor&/sens 1-2 nrv cndj tst $39.87
4 4 Payment Medicaid Most are Significant Procedures Not on Ancillary Policy list Use appropriate rate code; e.g., clinic (1432)
5 5 5 Medicaid Physician Billing For NY Medicaid, physician services are carved out of the APG payment for all services provided in hospital outpatient settings These services are billed separately under the Medicaid Physician Fee Schedule
6 6 Medicaid Other Practitioners The services of other licensed practitioners are always included in the APG payment to the facility and may not be billed separately in the hospital OPD setting Dentists (except for orthodontists) Nurse practitioners Midwives Podiatrists 6 6
7 Deleted Codes HCPCS DEPT SUBDEPT INVALID SVC DESC COMMENTS Valid through NEURODX EMG INVALID Nerve Cond Motor wo F-Wave 12/31/ to report see NEURODX EMG INVALID Nerve Cond Motor w F-Wave Valid through 12/31/ to report see NEURODX EMG INVALID Nerve Cond Motor Sens/Mixed Valid through 12/31/ to report see NEURODX EMG INVALID Intraop Nerve Test Hr Valid through 12/31/ to report see NEURODX EMG INVALID H-Refla&L Stud Ga/Sol Mm Valid through 12/31/ to report see Valid through NEURODX EMG INVALID H-Refl A&L Stud No Ga/Sol Mm 12/31/ to report see
8 8 New Codes for 2013 HCPCS DEPT SUBDEPT SVC DESC COMMENTS NEURODX EMG Motor&/sens 1-2 nrv cndj tst Valid 1/1/ NEURODX EMG Motor&/sens 3-4 nrv cndj tst Valid 1/1/ NEURODX EMG Motor&/sens 5-6 nrv cndj tst Valid 1/1/ NEURODX EMG Motor&sens 7-8 nrv cndj test Valid 1/1/ NEURODX EMG Motor&sen 9-10 nrv cndj test Valid 1/1/ NEURODX EMG Motor&sen nrv cnd test Valid 1/1/ NEURODX EMG Motor&sens 13/> nrv cnd test Valid 1/1/ NEURODX EMG Ans parasymp & symp w/tilt Valid 1/1/ NEURODX EMG Ionm in operatng room 15 min Valid 1/1/ NEURODX EMG Ionm remote/>1 pt or per hr Valid 1/1/ NEURODX EMG Parasymp&symp hrt rate test Valid 1/1/ NEURODX SLEEP Polysom <6 yrs 4/> paramtrs Valid 1/1/ NEURODX SLEEP Polysom <6 yrs cpap/bilvl Valid 1/1/2013
9 9 Change for NCSs 2013 Changes for Nerve Conduction Studies 2012 codes , 95903, were charged per study of named branch of nerve Motor or sensory were charge separately Multiple units were reported 2013 codes are charged per study Motor and Sensory are combined Codes are defined in number of units, e.g., NCS; 5-6 studies MUEs are for 1 unit each
10 10 NCS Unit of Service Unit is per nerve, or named branch of nerve LCD L26869 See Appendix J of the CPT Manual Lists Motor and Sensory nerves that constitute one unit of service Documentation should support billed units as described in Appendix J
11 11 Good News/ Bad News Good News Professional reporting increased fees to cover decrease in units Bad News Technical/facility reporting did not
12 12 Professional Fee 2012 the average fee per study ( ) was $22.46 (not weight adjusted) 2013 HCPCS Description Payment per study Motor&/sens 1-2 nrv cndj tst $ Motor&/sens 3-4 nrv cndj tst $ Motor&/sens 5-6 nrv cndj tst $ Motor&sens 7-8 nrv cndj test $ Motor&sen 9-10 nrv cndj test $ Motor&sen nrv cnd test $ Motor&sens 13/> nrv cnd test $12.80
13 13 Professional Fee CMS estimates that payments to neurologists will decrease [in 2013] by seven percent (-2% work RVU+-5% practice expense RVU) According to CMS, the reduction is a result of the potentially misvalued code initiative, which impacted EMG and nerve conduction tests From the American Academy of Neurologyhttp://
14 14 APC Rate 2012 HCPCS Description APC Rate Motor nerve conduction test $ Motor nerve conduction test $ Sense nerve conduction test $ HCPCS Description APC Rate Motor&/sens 1-2 nrv cndj tst $ Motor&/sens 3-4 nrv cndj tst $ Motor&/sens 5-6 nrv cndj tst $ Motor&sens 7-8 nrv cndj test $ Motor&sen 9-10 nrv cndj test $ Motor&sen nrv cnd test $ Motor&sens 13/> nrv cnd test $79.83
15 15 Bilateral Carpal Tunnel Nerve Conduction Study Example: Motor nerve study: R Median, R Ulnar; Sensory nerve study: R Median, R Ulnar, R Radial, L Ulnar (with same F-wave studies) x 2, x 4 APC payment =$ (unadjusted) x 1 (Motor&/sens 5-6 nrv cond test) APC payment =$ (unadjusted)
16 16 Report New 2012 EMG Codes New add-on codes for 2012 EMG add-on codes reported with NCS primary codes ALWAYS report these codes in conjunction with NCS codes NEVER report these codes in conjunction with EMG codes , (CCI edits) CPT Description APC Rate Musc tst done w/nerv tst lim $ Musc test done w/n test comp $ Non-extrem EMG same day as NCS $43.11
17 17 Setting Charges for 2013 Set your charges based on 2012 data Will mean larger mark-up from APC for 2013 CMS will use this data to set the payments going forward.
18 18 Pediatric Polysomnography Two new codes (95782, 95783) have been created to report pediatric polysomnography for children younger than 6 years of age These patients are typically monitored for a longer period of time than adults (on average 9 hours) and typically require a 1:1 technologist to patient ratio Pediatric studies tend to be more complex to review due to longer recordings and more data From the American Academy of Neurologyhttp://
19 19 Intraoperative Neurophysiology Code has been deleted Two new codes ( and ) for neurophysiology monitoring either inside or outside the operating room New code is reported per 15 minutes of service and requires reporting only the portion of time the monitoring professional was physically present in the operating room providing one on one patient monitoring, and no other cases may be monitored at the same time New code is reported for all cases in which there was no physical presence by the monitoring professional in the operating room during the monitoring time or when monitoring more than one case while in an operating room From the American Academy of Neurologyhttp://
20 20 Questions and Discussion
21 21 Richard Cooley Contact Us Phone: Jean Russell Phone:
22 22
23 23 CPT Current Procedural Terminology (CPT ) Copyright 2012 American Medical Association All Rights Reserved Registered trademark of the AMA
24 24 Disclaimer Information and opinions included in this presentation are provided based on our interpretation of current available regulatory resources. No representation is made as to the completeness or accuracy of the information. Please refer to your payer or specific regulatory guidelines as necessary.
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