Coding and Compliance: Get the Skinny on Neurology Injection and Infusion Codes

We had a big movement again in the medicine section. Our fairly new codes came out few years ago for hydration, therapeutic, prophylactic, diagnostic injections and infusions. They were in the 907 range. They have now been moved to the 936 range. And so, primarily it was allowed for a more convenient comparison to the chemotherapy codes and other complex infusion services codes that were back in that 936 section for accurate medical coding and billing.

We have absolutely no change in the RVU evaluation. They now have a shared section guideline. So it was moving them more into a more typical area. Note, we do have a crosswalk available in Appendix N if you get lost and can't find them.

If your providers are doing IM injections in the office, that code would go from 90772 the new code will be 96372. So, 90772 will go to 96372. If you're doing IV infusions in a treatment center in your office setting - neurologists are performing sometimes IV therapeutic infusions for the treatment of multiple sclerosis, we're going to go from the 90765 and 90766 to the 96365 code. That's for our first hour infusion and 96366 for each additional hour. So, we're just moving over from the 907 range to the 963 range.

We have a (butal) of new category two codes that were added. Remember, our category two codes are still optional. They're not required for correct medical coding and billing but they're also not a substitute for category one codes.

Some commercial payers are now starting to encourage providers who also report the category two codes for their claims. It's not just Medicare. Besides, back pain is a new one that was added. We've had some new performance measures. Some revisions about - we also have many geriatric ones and some revisions in category two codes and the major depressive disorder and also some new preventive screening advices for smokers to quit.

We had a deletion. This is a key deletion for neurology practices in the CPT. As per the updated medical coding guidelines, Modifier -21 was deleted. Basically the AMA came that they no longer want to have a duplicate mechanism to report prolonged services by having modifier -21 along with the prolonged services add-on codes, the 99354 through 99359, by having duplicate mechanisms that violated that CPT concept of having unique methods of reporting those, it no longer will have that mechanism to report E/M services for less than 30 minutes longer than the established time.

Typically, that's why we were seeing modifier -21 used when it was longer than the established time but less than 30 minutes. We will no longer have an appropriate method to report those because again, our prolonged service codes require that it's 30 minutes or greater. The only difference though is modifier -21 - most providers that reported that to any consistency had difficulty getting any additional payment.

Medical coding Updates: Moving on to HCPCS, we have a new J Code. I need to point out in your code description for J1953 I left out an A. So the spelling of that is actually LEVETIRACETAM. That's levetiracetam. Its trade name is Keppra. It's typically used in treating partial onset or myoclonic seizures in patients with epilepsy.

It's often used along with other anticonvulsants and also can be used off label to treat neuropathic pain. The key thing here is that we're not going to report this for a prescription for the oral drug. This needs to be an injection.

We've also had a new code added for triamcinolone acetonide. The trade name is Trivaris. The key thing here is that it's preservative free and that it's 1 mg. It's more frequently used in eye injections but it can also be administered IM and intra-articular. We have this new code for preservative free we did have a revision to the code J3301. That's an injection of triamcinolone acetonide. That's 10 mgs, where they added is it's not otherwise specified.

So, we have a code for preservative free and we have a code for not otherwise specified. That is 10 mgs. So, note the difference in milligrams between the code description, J3300 is 1 mg and our existing code J3301 still remains at 10 mgs.

Keeping in line with the medical coding updates, We have a few new HCPCS codes that Medicare has included so that we can easily report the Medicare performance measures. That's for the new initiative for PQRI. We had the G8493, G8502. These are for the back pain. We have some new ones for the pain assessment and pain severity quantified. So, there are several G85 codes.

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