Medical billing codes are crucial in healthcare reimbursement, facilitating communication between providers, insurance companies, and government agencies. Understanding these codes is essential for accurate billing and efficient reimbursement in neurology. This blog entry will explore a few of the standard neurology-related medical billing codes, shedding light on their importance and usage.
Evaluation and Management (E/M) Codes:
Evaluation and Management (E/M) codes document and bill for patient encounters, including office visits, consultations, and hospital visits. These codes are based on the complexity and intensity of the patient’s condition and the level of service provided by the healthcare provider. In neurology, E/M codes are frequently used for initial evaluations, follow-up visits, and consultations. critical care emergency medicine billing of Neurology specialize in navigating the intricacies of insurance coverage for neurological procedures, ensuring maximum reimbursement for neurologists and clinics.
CPT codes range from 99201 to 99215, with each code representing a different level of service based on factors such as history, examination, and medical decision-making.
Electroencephalography (EEG) Codes:
An EEG test is a diagnostic procedure that looks for brain electrical activity anomalies. Common indications for EEG include seizure disorders, epilepsy, and evaluation of altered mental status. Proper coding for EEG services ensures accurate reimbursement for the test’s technical and professional components.
CPT codes for EEG include 95812 (Routine EEG), 95813 (EEG with video), and 95957 (Monitoring for localization of cerebral seizure focus).
Electromyography (EMG) and Nerve Conduction Studies (NCS) Codes:
EMG and NCS are diagnostic tests used to evaluate the function of nerves and muscles. These tests are often performed to diagnose conditions such as peripheral neuropathy, radiculopathy, and myopathy. Proper coding for EMG and NCS procedures is essential for accurate reimbursement.
CPT codes for EMG and NCS include 95860 (Needle EMG), 95905 (Nerve conduction studies, 1-2 studies), and 95937 (Needle EMG, each extremity).
Injection and Infusion Codes:
Neurologists often administer injections and infusions to treat various neurological conditions, such as migraine headaches, spasticity, and multiple sclerosis. Proper coding for these procedures ensures accurate reimbursement for the medications administered and the associated services. Dermatology billing offered by our dedicated team are tailored to meet the specific needs of skin care practices, optimizing revenue streams and minimizing billing errors.
CPT codes for injection and infusion services include 96372 (Therapeutic, prophylactic, or diagnostic injection), 96365 (Intravenous infusion, for therapy, prevention, or diagnosis), and 64415 (Injection, anesthetic agent; brachial plexus).
Neurostimulator Programming Codes:
Neurostimulation therapy is a treatment option for patients with chronic pain, movement disorders, and epilepsy. Neurologists often program and adjust neurostimulator devices to optimize patient outcomes. Proper coding for these services ensures accurate reimbursement for the time and expertise required.
CPT codes for neurostimulator programming include 95970 (Electronic analysis of implanted neurostimulator pulse generator system).
Neurological Imaging Codes:
Neuroimaging is essential for diagnosing and managing various neurological conditions, including stroke, brain tumors, and neurodegenerative diseases. Proper coding for imaging studies ensures accurate reimbursement for the technical and professional components of the procedure.
Sleep Study Codes:
Severe breathing while asleep, sleep deprivation, and other sleeping conditions, including narcolepsy, are commonly seen in neurology practices. Both household breathing testing (HSAT) and polysomnography (PSG) are diagnostic tests used to evaluate sleep disorders and guide treatment decisions. Proper coding for sleep studies is crucial for accurate reimbursement and appropriate utilization management.
Neuropsychological Testing Codes:
Neuropsychological testing is used to assess cognitive function, memory, and behavior in patients with neurological conditions such as dementia, traumatic brain injury, and attention deficit hyperactivity disorder (ADHD). Proper coding for neuropsychological testing ensures accurate reimbursement for the time and expertise required to administer and interpret these tests.
Neurology Consultation Codes:
Neurologists often consult with patients referred by primary care physicians or other specialists to evaluate and manage neurological conditions. Proper coding for consultation services ensures accurate reimbursement for the comprehensive evaluation and management provided by the neurologist.
CPT codes for neurology consultations include 99241 (Office consultation for a brand-new or current patient who needs the opinion or advice of a neurologist), 99242 (Consultation with moderate complexity), and 99243 (Consultation with high complexity).
Intrathecal Drug Delivery System (IDDS) Codes:
Intrathecal drug delivery systems (IDDS) are implantable devices that administer the medication directly into the spinal fluid to treat chronic pain, spasticity, and severe spasmodic disorders. These systems often require periodic refills and adjustments, necessitating specific billing codes for reimbursement.
CPT codes for IDDS services include 62362 (Refilling and maintenance of an implanted pump or reservoir for intrathecal or epidural drug infusion), 95991 (Refilling and maintenance of an implanted infusion pump or reservoir for drug delivery), and 95993 (Catheter maintenance and revision of intrathecal or epidural drug infusion system).
Botulinum Toxin Injection Codes:
Botulinum toxin injections are commonly used in neurology to treat conditions such as cervical dystonia, spasticity, and chronic migraine. Proper coding for botulinum toxin injections ensures accurate reimbursement for the medication and associated services, including injection administration and follow-up care.
CPT codes for botulinum toxin injections include 64612 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for cervical dystonia, spasmodic torticollis]) and 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]).
Telemedicine Services Codes:
Telemedicine has become increasingly important in neurology, allowing for remote consultations, follow-up visits, and monitoring of patients with neurological conditions. Proper coding for telemedicine services ensures accurate reimbursement for virtual patient encounters, adhering to specific billing guidelines and regulations.
CPT codes for telemedicine services include 99201-99215 (Evaluation and management services), along with specific telehealth modifier codes such as GT (via interactive audio and video telecommunications systems) and 95 (a real-time participatory audio and video telephone system used to provide simultaneous medical services).
Genetic Testing Codes:
Testing for genes is becoming more and more critical in neurology for the diagnosis and management of inherited neurological disorders, such as Huntington’s disease, amyotrophic lateral sclerosis (ALS), and hereditary neuropathies. Proper coding for genetic testing ensures accurate reimbursement for these specialized laboratory services, including the analysis of DNA sequences and interpretation of results.
CPT codes for genetic testing include 81401 (Molecular pathology procedure, Level 1 [e.g., identification of a single germline variant]) and 81403 (Molecular pathology procedure, Level 3 [e.g., identification of 2-5 germline variants]).
Functional Neurological Evaluation Codes:
Functional neurological evaluations assess patients’ abilities to perform daily activities and evaluate the impact of neurological impairments on their functional independence and quality of life. These evaluations help guide treatment planning and rehabilitation strategies for patients with neurological conditions such as stroke, traumatic brain injury, and movement disorders.
CPT codes for functional neurological evaluations include 97750 (Physical performance test or measurement [e.g., musculoskeletal, functional capacity], with a written report, every 15 minutes) and 97755 (Assistive technology assessment, direct one-on-one contact, with written report).
Continuous EEG Monitoring Codes:
Continuous EEG monitoring is used in the intensive care unit (ICU) to monitor patients with acute neurological conditions such as status epilepticus, traumatic brain injury, and encephalopathy. Proper coding for continuous EEG monitoring ensures accurate reimbursement for the ongoing monitoring and interpretation of brain electrical activity.
CPT codes for continuous EEG monitoring include 95708 (Electroencephalogram [EEG] monitoring, interpretation, and report [including review of prior EEG monitoring, if available], every 24 hours) and 95718 (EEG monitoring for localization of cerebral seizure focus, every 24 hours).
Home Health Care Services Codes:
Neurology patients with complex medical needs often require home healthcare services to manage their conditions and optimize their quality of life. Proper coding for home health care services ensures accurate reimbursement for skilled nursing care, physical therapy, occupational therapy, and other services provided in the patient’s home setting.
Conclusion:
As the field of neurology continues to evolve, so do the medical billing codes used to document and bill for the diverse array of services provided to patients with neurological conditions. Neurologists must understand and correctly apply these codes to ensure accurate reimbursement, minimize claim denials, and maintain compliance with coding guidelines and regulations.