Neurology & Pain Management Coding Alert

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1 The Coding Institute AVOID AUDITS.IMPROVE REIMBURSEMENT.REDUCE DENIALS.INCREASE REVENUE Also Access Your Alert Online at Neurology & Pain Management Coding Alert Your practical adviser for ethically optimizing coding, payment, and efficiency in neurology and pain management practices October 2012, Vol. 14, No. 10 (Pages 73-80) In this issue CPT 2013 Don t Miss the Updated Chemodenervation Codes Including One for Migraine Treatment Plus: Many E/M and some pain pump codes cover more providers now. Billing Corner Need Help Untangling Primary vs. Secondary Payer Challenges? Try These Tips Know the coordination of benefits and what each payer pays. p75 p76 You Be the Coder p76 Correct Reporting for Q-EEG Reader Questions Don t Forget J Code and FB Modifier for Injections Administered p77 Coding Tips } Steps Ease Your Nerve Conduction Studies Reporting Key: Count required units and append modifiers to avoid denials. When reporting nerve conduction studies (NCS), you can avoid denials by reporting the correct number of units and appending the needed modifiers. Four factors govern your code choice:»»»» which nerve was tested; how many nerves in total were tested; whether the physician completed an F-wave study; and if any pre-configured devices were used. Check out our advice below on rightful NCS reporting and put an end to your denials for these procedures. 1. Identify the Motor or Sensory Nerve When your neurologist performs a nerve conduction test, first determine if he tested a motor or sensory nerve. CPT gives you different choice of codes for the two types. For motor nerve testing, report (Nerve conduction, amplitude and latency/ velocity study, each nerve; motor, without F-wave study) or (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study), depending upon whether the F-wave study was done. Identify EEG and ECG as Distinct Procedures For Same Region, Keep to Single p78 p78 For sensory nerve testing, report (Nerve conduction, amplitude and latency/ velocity study, each nerve; sensory). 2. Count the Nerves Tested Check For Non-Duplication in Critical Care Services p79 Resort to for Lumbar Sympathetic Chain RF p79 Pay close attention to the diagnostic study report to determine how many nerves your neurologist tested. Remember that your neurologist may actually have performed the testing at multiple sites on the same nerve. In this case, you will report only one and not multiple nerves. Appendix J of the CPT codebook is extremely helpful in distinguishing between testing of separate nerves versus testing on multiple sites of a single nerve, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO. It lists the individual branches of motor, sensory and mixed nerves, with each listing representing a separate and distinct nerve 2012 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713

2 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Editorial Advisory Board Neil A. Busis, MD Chief, Division of Neurology Shadyside Hospital, Pa. Laurie A. Castillo, CPC, CPC-H, CCS-P President and Owner Professional Coding & Compliance Consulting, Va. AAPC National Advisory Board Member Past President, AAPC Northern Virginia Chapter Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC President, CRN Healthcare Solutions, Tinton Falls, N.J. Bruce H. Cohen, MD, FAAN Chief, Section of Pediatric Neurology and Co-Director, Brain Tumor Center Cleveland Clinic Foundation, Ohio Steven W. Dibert, MD Stroke Director, Charlotte Medical Center - Main Charlotte, N.C. Anne M. Dunne, RN-BC, MBA, MSCN Director of Healthcare Consulting, Grassi & CO, Jericho, NY Ian S. Easton, PhD, FACMPE Past President, American College of Medical Practice Executives; Department Head Applied Technology Coastal Georgia College, Ga. Barry Haitoff, CHBME President, Medical Management Corporation of America, N.Y. Janet McDiarmid, CMM, CPC, MPC Past President American Academy of Professional Coders, National Advisory Board Patricia M. Salmon President, Patricia M. Salmon & Associates Ltd., Pa. Susan L. Turney, MD, FACP Medical Director, Reimbursement Marshfield Clinic, Wis. James Vavricek Policy Director American Association of Electrodiagnostic Medicine Marianne Wink, RHIT, CPC, ACS-EM University of Rochester Medical Center Department of Neurology - Coding Manager conduction study. For example, sensory nerve conduction study (NCS) of the median sensory nerve to the second digit with testing at both the mid-palm and wrist would constitute a single study; whereas sensory NCS testing of the median sensory nerve to the second digit and ulnar sensory nerve to the fifth digit constitutes two separate diagnostic studies and each NCS would be reported with a unit of service. Note: The CPT descriptors for codes 95900, 95903, and mention each nerve. This implies that you report a single unit of these codes for every nerve tested. You will not report multiple units of these codes if your neurologist does the testing at multiple sites on a single nerve. 3. Bill the Professional Component You append modifier 26 (Professional component) to indicate that your physician did only the interpretation and reporting when billing for the NCS codes All of the electrodiagnostic studies, including nerve conduction study codes have professional and technical components, says Hammer. If the neurologist is only performing the professional interpretation of nerve conduction studies performed by a non-employee technician, then the neurologist would likewise only bill with modifier 26 also. Editor s Note: For more steps in reporting the nerve conduction studies, see the next issue of Neurology Coding Alert, Vol. 14, No. 11. q Need a Refresher on Nerve Conduction Basics? Your neurologist will use nerve conduction studies (NCS) to test the function and electrical conduction of the motor and sensory nerves. The nerve is stimulated by an electrode and the conduction time (latency) is measured by another electrode placed at another point on the nerve. The amplitude of response is also recorded. Note: The CPT descriptors for NCS codes mention the recording of both latency/velocity and amplitude. When your physician does F-wave study, it implies that supramaximal stimulation of a motor nerve was done and action potentials were recorded from a muscle supplied by the nerve. This helps determine the time for the electrical stimulation to travel from the nerve in the limb, to the spine, and back to the nerve again. Tip: The F-wave study helps determine the conduction velocity of the nerve between the limb and spine. Motor and sensory nerve conduction studies, by contrast, help to determine the conduction velocity in a segment of nerve in the limb. q Neurology & Pain Management Coding Alert (USPS ) (ISSN ) is published monthly 12 times per year by The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute. All rights reserved. Subscription price is $299. Periodicals postage is paid at Durham, NC and additional entry offices. POSTMASTER: Send address changes to Neurology & Pain Management Coding Alert, 2222 Sedwick Drive, Durham, NC p74

3 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Suite #101, Durham, NC The Coding Institute SPECIALTY ALERTS CPT 2013 } Don t Miss the Updated Chemodenervation Codes Including One for Migraine Treatment Plus: Many E/M and some pain pump codes cover more providers now. The American Medical Association (AMA) has released information on CPT code changes for 2013, including two revisions and an addition to your chemodenervation options. Be Confident With Reporting Multiple 64612s CPT 2013 clarifies longstanding questions from coders and pain management specialists regarding usage. The code describes chemodenervation of muscles innervated by the facial nerve to treat conditions such as blepharospams (333.81, Other extrapyramidal disease and abnormal movement disorders; blepharospasm) or hemifacial spasm (351.0, Facial nerve disorders; Bell s palsy). Opinions have varied regarding whether you can legitimately report multiple times if the physician performs chemodenervation on the facial nerve (cranial nerve VII) during the same encounter. The Medicare Physician Fee Schedule (MPFS) lists as a code that allows bilateral reporting, but the revised descriptor for 2013 puts the question to rest: (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve, unilateral [e.g., for blepharospasm, hemifacial spasm]). Bottom line: You can report two units of if your physician administers chemodenervation to muscles innervated by the facial nerve on both sides of the patient s face. Indicate the situation on Medicare claims by appending modifier 50 (Bilateral procedure) to For non-medicare payers, report on two separate lines with modifiers LT (Left side) and RT (Right side) appended. This helps immensely in clarifying the discrepancy between Medicare s stance that could be reported as bilateral, and the AMA s stance that it would be reported only once for all injections, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. Plus: In a similar revision, when CPT 2013 goes into effect, will specifically represent chemodenervation to a single extremity. The new descriptor reads as follows: Chemodenervation of muscle(s); extremity and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis). Add for Chronic Migraine Treatment A new addition to your chemodenervation options in 2013 will be (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]). Currently: Until goes into effect, providers potentially report both and if they inject the muscles in the forehead area as well as muscles in the back of the head or upper neck area during the same encounter to treat chronic migraine. In those situations, a question arose regarding whether the provider could report both codes bilaterally, which could lead to potentially high reimbursement when compared to multiple Botulinum injections of an extremity. Introducing answers the question by offering a single code for the multiple-injection scenario. Take Advantage of Expanded Provider Inclusions If your provider reports E/M services or certain fluoroscopy codes, check the updated descriptors in Many now include services by other qualified health care provider instead of only a physician. For example, the explanation with many E/M office visit codes now reads, Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, XX minutes are spent face-to-face with the patient and/or family. Differences: Previous descriptors stated that the counseling and/or coordination of care took place with other providers or agencies. The face-to-face time (Continued on next page) p75

4 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC associated with each code also was attributed to the physician instead of being open to physicians or other qualified providers. Clarification: The updated code descriptors coincide with CPT s 2012 Instructions for Use that defined other health care provider as an individual who is qualified by education, training, licensure/regulation (when applicable) and facility privileges (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from clinical staff who work under the supervision of a physician or other qualified health care professional. Pump refill change: Code also will apply to other qualified health care professionals instead of only physicians. The revised descriptor is as follows:» Electronic analysis of programmable, implanted pump for intrathecal or epidural drug Billing Corner } Need Help Untangling Primary vs. Secondary Payer Challenges? Try These Tips Know the coordination of benefits and what each payer pays. If you have questions about primary and secondary payers, our experts have answers especially when one of the payers in question is Medicare. Read through these FAQs to maximize your practice s reimbursement and reduce the costs of administering claims for patients covered by more than one payer. We Want to Hear From You Tell us what you think about Neurology & Pain Management Coding Alert. What do you like? What topics would you like to see us cover? What can we improve on? We d love to hear from you. Please Tarveen Jandoo at [email protected] Thank you in advance for your input! infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional) Many mid-level providers already successfully manage implanted intrathecal pumps, says Anne M. Dunne, RN- BC, MSCN, MBA, director of healthcare consulting for Grassi and Co. in Jericho, N.Y. In that instance, providers report (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill). In New York State, there s a minor $5 difference in the Medicare fee schedule between codes and 62370, Dunne adds. I suspect this new change will have little to no impact on how neurology practices manage this clinical service or the associated reimbursement they would budget. q Who Is Responsible for Knowing About Primary vs. Secondary? There is no exact, easy answer to this question, but everyone should be aware of which insurance that patient has. Ideally, the patient should know but that is not usually the case, says Linda Huckaby, CMA (AAMA), with Carolina Medical Rehabilitation in Greenville, S.C. Everyone provider, patient, and payer has a responsibility to know, adds coding, billing, and practice management consultant Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS, in Orlando, Fla. The You Be the Coder Correct Reporting for Q-EEG What is the appropriate code for quantitative electroencephalography (Q-EEG)? Alaska Subscriber See page 78. q p76

5 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Suite #101, Durham, NC The Coding Institute SPECIALTY ALERTS provider should know because they need to know who the claim is to be sent to if the patient has covered health benefits. The medical biller who works for the provider should know for the same reason. The patient should know so that they seek care from doctors who are networked with their insurance plans, which may be outlined in their contract with the insurance company. Also it is important to know to make sure that if any of the patient s insurance(s) requires pre-authorization for any of the provider s services, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. Ask the patient for his insurance information before rendering services, and check whether the patient if he has more than one plan. It is the responsibility of the practice to identify primary and secondary because billing done incorrectly slows the revenue flow, Huckaby adds. The payer will always have some clue as to primary and secondary, although sometimes that information is incorrect and requires assistance from the patient. Best bet: Verify a patient s insurance coverage before you bill the service. Verification means checking the patient s insurance information to be sure that a patient belongs to the group you re billing and that her group and member identification are correct. Obtain this information prior to the patient s initial visit when possible. If your practice verifies eligibility and benefits prior to an appointment, sometimes the insurance companies will indicate that other insurance coverage exists. That lets you know ahead of time that you should speak to the patient regarding the primary/secondary coverage. Work faster: Take advantage of payer Web sites to make insurance verification less time-consuming. Find out whether payers you deal with have verification Web sites, Reader Questions } Don t Forget J Code and FB Modifier for Injections Administered The patient needs injections of vitamin B12 and carries her own medication to our neurologist s office. The patient is administered the injection every two weeks. In this case, can we report code 99211? New Jersey Subscriber and sign up for them. Some clearinghouses also offer verification services. Ask the patient: Have good patient registration and insurance forms to collect all the information you ll need. Make sure there is room for the patient to list a secondary payer. Ask front-desk personnel to look immediately at the form for any missing information. Also ask returning patients if their information has changed, and get a new copy of the insurance card(s). What Does the Secondary Pay? The secondary plan must determine the amount of benefits it would normally pay if no coordination existed and apply that amount to unpaid covered charges owed by the insured after any benefits have been paid by the primary payer. The payable amount must include deductibles coinsurance and copays owed by the insured. The secondary plan can use its own deductibles coinsurance and copays to determine the amount it would have paid had it been primary. It can apply only its own deductibles coinsurance and copays to the total allowable expenses not to the amount owed after payment by any primary plan. The secondary plan has no obligation to pay for any services that it does not cover as a benefit. A practice should never expect reimbursement from the primary and secondary insurer to total more than the service charges. The purpose of coordination of benefits (COB) is to make sure insurance payments for patients with duplicate health insurance coverage do not exceed the cost of the services. When a secondary insurer acts on your claim, check the payer s COB clause to see if it followed its own rules. Ask the insurer s customer service representative to explain its COB rules and request a copy in writing. A company s Web site may also explain how to handle COBs. You can also ask patients for copies of their insurance policies so you ll have complete information. q You are not correct to report code (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician ) for the injections that the patient is receiving. The correct code that you may report (Continued on next page) p77

6 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC is (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). You may or may not report J3420 (Injection, vitamin B- 12 cyanocobalamin, up to 1000 mcg). You will report the J code ONLY if required by the payer as the J3420 is NOT a cost to the practice. If that is the case, then the practice can append FB (Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device [examples, but not limited to, covered under warranty, replaced due to defect, free samples]) modifier and bill with a $0.00 amount. If not required by the payer, you would not bill for the J code at all. q Identify EEG and ECG as Distinct Procedures Our clinician performed an EEG on a patient. He also documented that the patient underwent an ECG. Can we report codes and together? We have been Correct Reporting for Q-EEG You Be the Coder (Question on page 76) Q-EEG, used as an adjunct to conventional EEG in the diagnosis of certain neurological conditions, is an extended analysis of EEG using computer technology that uses multiple electrodes and digitizes electrical brain wave activity. The topographic brain mapping can be be analyzed to show progressive changes in neurophysiological function. It is also referred to as Brain Electrical Activity Mapping (BEAM). You may report code (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]) for Q-EEG. Some payers reference to HCPCS code S8040 (Topographic Brain Mapping) in addition to/or instead of the code. Note: is not an add-on code, but you need to bill it with one of the other CPT codes for EEG (95816, 95819, 95822, 95812, 95813, 95951, and 95953). Also, some payers may deny with q getting denials for though we did document that the reason for ECG was chest pain. Please help. Ohio Subscriber Yes, you can report codes (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended) and (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation) together. Regarding your denial, there isn t a bundle that prevents reporting the two codes together. Check whether a local coverage determination (LCD) policy is applicable in your state. If so, make sure you are reporting the diagnosis code from the ICD-9 list available in the LCD policy. q For Same Region, Keep to Single The physician documented that he performed blocks at T8, T9, T10, and T11. He coded four times, but I m not sure that s correct. Is it? Michigan Subscriber Unfortunately, your physician recommended incorrect coding for this service; fortunately, you caught it so won t submit an erroneous claim. The descriptor for (Injection, anesthetic agent; intercostal nerves, multiple, regional block) encompasses multiple, regional block. Because of that, you should report only once for the injections performed since they re all in the same spinal region (thoracic). Also note: The other spinal regions don t include intercostal nerves. Code and its companion code (Injection, anesthetic agent; intercostal nerve, single) aren t structured like other nerve injection code sets for single and each additional injections. Instead, you have one code for injection to a single nerve and one code for multiple nerves. Both codes should be reported with a maximum of 1 unit of service. q p78

7 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Suite #101, Durham, NC The Coding Institute SPECIALTY ALERTS Check For Non-Duplication in Critical Care Services Our neurologist provided consultant services to a patient who was under critical care in the ICU. The primary attending doctor was the primary attending clinician. Can we report the critical care codes for our neurologist s services? New Mexico Subscriber To report critical care services, you have an option of (Critical care, evaluation and management of the critically ill or critically injured patient; first minutes) and (Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes [List separately in addition to code for primary service]) depending upon the time for the evaluation and management. You will need to be specifically clear for the primary attending doctor. It isn t clear in your question if the primary attending doctor was the hospital intensivist or was the internal medicine physician. Verify the situation with the primary attending clinician since you won t be able to report if another neurologist from your group practice attends to the same patient on the same calendar date. However, you can bill for your neurologist s services if the primary attending clinician and your neurologist are from different specialties and you can document that the services meet critical care requirements, i.e., there was a medical rationale for the service and it was non-duplicative. Medicare specifies while more than one physician may provide critical care services to a patient during the critical care episode of an illness or injury, each physician must be managing one or more critical illness(es) or injury(ies) in whole or in part. When the group physicians are providing care that is unique to his/her individual medical specialty and managing at least one of the patient s critical illness(es) or critical injury(ies) then the initial critical care service may be payable to each. q Resort to for Lumbar Sympathetic Chain RF I ve read that we should report for radiofrequency of the lumbar sympathetic chain, but one of our physicians insists that we should code with What s the correct approach? West Virginia Subscriber CPT currently does not include a code that represents radiofrequency destruction of the lumbar sympathetic chain. Because of this, the information you ve read is correct: Submit (Unlisted procedure, nervous system). It can be difficult to get paid for unlisted codes, so drop the claim to paper and submit it with dictation and supporting documentation explaining the procedure. Background: The CPT codebook separates the Destruction by Neurolytic Agent procedures into two sections Somatic Nerves and Sympathetic Nerves. The somatic nervous system is made up of nerves that connect to the skin, sensory organs and all skeletal muscles. The system is responsible for nearly all voluntary muscle movement as well as processing sensory information that arrives via external stimuli including hearing, touch and sight. Note that code is included under the Somatic Nerves section. In contrast, the sympathetic nerve system is a primitive alternate nervous system that is considered to be usually outside our conscious control. It controls the amount of blood going through the arteries, the heart rate, breathing rate, etc. The lumbar sympathetic chain is found anteriorly to the L2, L3 and L4 vertebral bodies with communication to the thighs, legs and feet. The sympathetic nervous system potentially is involved in some pain conditions such as complex regional pain syndrome, formerly known as reflex sympathetic dystrophy (337.2x, Disorders of the autonomic nervous system; reflex sympathetic dystrophy). Reviewing the CPT code options in the Sympathetic Nerves section, note there is no listing specifically for lumbar sympathetic, only celiac plexus and superior hypogastric plexus. CPT directs providers to Select the name of the procedure or service that accurately identifies the service performed. Do not select a procedure code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code q Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver. p79

8 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC AVOID AUDITS.IMPROVE REIMBURSEMENT.REDUCE DENIALS.INCREASE REVENUE Neurology & Pain Management C O D I N G A L E R T We would love to hear from you. Please send your comments, questions, tips, cases, and suggestions for articles related to Neurology & Pain Management Coding Alert to the Editor indicated below. Tarveen Jandoo, MD [email protected] Senior Editor Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO Consulting Editor Mary Compton, PhD, CPC [email protected] Editorial Director and Publisher Jennifer Godreau, CPC, CPMA, CPEDC [email protected] Director of Development & Operations Leigh Delozier, CPC [email protected] Co-Editor The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Tel: Fax: [email protected] Neurology & Pain Management Coding Alert is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. If legal advice or other expert assistance is required, the services of a competent professional should be sought. CPT codes, descriptions, and material only are copyright 2012 American Medical Association. All rights reserved. No fee schedules, basic units, relative value units, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. Rates: USA: 1 year. $299. Bulk pricing available upon request. Contact Medallion Specialist Team at [email protected]. All major credit cards accepted. This publication has the prior approval of the American Academy of Professional Coders for 0.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the content. To access each issue s CEU quiz, visit Supercoder.com/ceus and then login. To request login information, [email protected] The Coding Institute also publishes the following specialty content both online and in print. Call for a free sample of any or all of the specialties below: Part B (Multispecialty) Anesthesia Billing & Collections Cardiology Dermatology Emergency Medicine Family Medicine Gastroenterology General Surgery Health Information Compliance ICD-10 Coding Internal Medicine Neurosurgery Ob-Gyn Oncology & Hematology Ophthalmology Optometry Coding and Billing Orthopedics Otolaryngology Pathology/Lab Pediatrics Physical Medicine & Rehabilitation Podiatry Psychiatry Pulmonology Radiology Rehab Report Urology Call us ( ) and mention your customer number for a special price, free trial, or just to find out more about SuperCoder the complete online medical coding solution. Order or Renew Your Subscription! Yes! Start/Renew my one-year subscription (12 issues) to Neurology & Pain Management Coding Alert Print & Online - $299 $249! Online only - $199 Name Title Company Address City, State, ZIP Phone Fax * Must provide address if you choose online or both option to receive issue notifications To help us serve you better, please provide all requested information Payment Options Charge my: MasterCard VISA AMEX Discover Card # Exp. Date: / / Signature: Check enclosed (Payable to The Coding Institute) Bill me (please add $15 processing fee for all bill me orders) Neurology & Pain Management Coding Alert The Coding Institute PO Box Atlanta, GA Call Fax [email protected] Promo Code: P92RAA01 Also Access Your Alert Online at p80