Coding and Billing are two critical factors in the world Neurology providers. This can be complex especially when the codes keep changing often which also calls for an extensive documentation. In the year 2019, neurologists have already seen and had to deal with many CPT code changes. Therefore, it is good to be updated about the changes so that the reimbursement becomes simpler with the billing services and coding support. This article attempts to bring out the CPT coding changes and its impact in 2019.
New CPT codes in Electrocorticography:
Electrocorticography (ECoG) – the recording of electrophysiological activity from electrodes placed directly on the exposed surface of brain. There is a new code for it.
- 95836 – Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, includes recording with an interpretation and a written report up to 30 days.
- Electrocardiography facilitates the recordings to be retained even after the patient’s discharge from the hospital. The CPT code 95386 keeps the ECoG recordings for a later view, it also allows storage and interpretation in a single day. The clinical documentation is supposed to contain the specific dates in the 30 days period.
Neurostimulators and analysis programming:
The programming codes of cranial nerve neurostimulator are now differentiated as simple or complex. They are no longer based on time. The simple programming of a neurostimulator pulse generator/transmitter comprises of 1 to 3 parameter adjustments whereas the complex programming includes adjustment of more than 3 parameters.
- 95976 – Electronic analysis of neurostimulator pulse generator/transmitter that is implanted (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by a physician or other qualified health care professional with simple cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional.
- 95977 – With complex cranial nerve stimulator pulse generator.
- Brain neurostimulator programming codes are reported depending on the face-to-face time which is differentiated by the first 15 minutes and every 15 minutes from there onwards.
- 95983 – With brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or any qualified health care professional.
- 95984 – With brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or a qualified health care professional.
Revised CPT codes: Three of the existing neurostimulator analysis CPT codes have been revised.
- 95970 - Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming.
- 95971 - with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or a qualified health care professional.
- 95972 – with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or a qualified health care professional.
Deleted CPT codes:
- In the revised CPT codes list, four CPT codes are deleted. So, refer 95976 & 95977 to report the cases relevant to codes 95974 and 95975 which have been deleted. Refer 95983 and 95984 to report the cases relevant to codes 95978 and 95979 which have been deleted.
- The services related to analysis and programming may be provided by a physician or any other qualified healthcare provider. The services can be with or without the support from manufacturer’s representative.
- There is a catch here, the services that are taken from the manufacturer’s representative need not be paid by the payer or the patient. The providers should be aware of the applicable policies from their local Medicare contractor or payer.
- In case, there is any additional evaluation and management service occurs, an evaluation and management code needs to be reported on top of the analysis and programming. In this case, modifier -25 should be appended to the evaluation and management code reported on the claim.
Other codes impacting Neurologists:
- 96112 – Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by a physician or a qualified health care professional, with interpretation and report; first hour
- 96113 – Additional 30 minutes must be put separately on the list along with a code for primary procedure.
- 96121 – Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by a physician or a qualified health care professional, both face-to-face time with the patient and time interpreting test results and the report preparation; each additional hour must be inserted in a separate list in addition to code for primary procedure.
The prominent changes with respect to the Neurostimulator Programming and Analysis, calls for a professional expert consultation. Considering the complexities, for a clean submission and payment, outsource your medical coding to an experienced medical coding company. It is also essential that the neurology providers understand the procedure and documentation requirements for proper coding and billing.
VP - Corporate Communications