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Medicine Neurology and Neuromuscular (medne neu)

By Laurie Hart,2014-04-26 19:31
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Medicine Neurology and Neuromuscular (medne neu)

     medne neu

    Medicine: Neurology and Neuromuscular 1

This section contains information to assist providers in billing for medicine procedures related to

    neurology and neuromuscular services.

    Polysomnography Providers should use the following codes to bill for polysomnography.

Sleep Evaluation: HCPCS Code Description

    Outpatient Services Z7600 Polysomnography, sleep evaluation, simple

    Z7602 Polysomnography, sleep evaluation, complex

    These codes cover all institutional services, including room charges,

    supplies, drugs, equipment and staff services. They are billed

    on a UB-04 claim. Codes Z7600 and Z7602 are not separately

    reimbursable when billed together by any provider, for the same

    recipient and date of service.

     Services personally performed by physicians are not included under

    these codes and are billed separately using appropriate codes. (See

    a following page for reimbursable codes.)

     Medi-Cal covers polysomnography when the patient has a history of

     severe sleep disturbances unexplained by physical evidence.

    Simple Test The simple test monitors respiration, heartbeat and transcutaneous

    O and CO. 22

    Complex Test The complex test includes electroencephalogram, electro-oculogram,

     electromyogram, electrocardiogram, nasal/oral airflow, oximetry, body

     position and respiratory effort (abdominal and chest. These

     components of complex polysomnography may not be billed

     individually in addition to polysomnography code Z7602. However, if

     gastroesophageal reflux (GER), arterial blood gases (ABG) and/or

     extremity electromyogram are medically necessary in addition to

     polysomnography, they may be performed and reimbursed

    individually

     in addition to code Z7602.

     Polysomnography performed as an outpatient service does not

     require authorization. Cases justifying hospitalization require

     authorization.

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Sleep Study and The following CPT-4 and HCPCS Level III codes must be used when

    Polysomnography: billing for sleep study and polysomnography for all patients, including Physician and Outpatient those at risk for possible Sudden Infant Death Syndrome (SIDS), Services regardless of age.

    Place of Service Codes The asterisked (*) codes should be used by physician and physician

    group providers who have established sleep study capabilities in their

    offices. Place of Service is restricted to the Place of Service office

    code “11” and clinic code “53,” “71” or “72” on the CMS-1500 claim

     or the Place of Service office code “79” or clinic code “71,” “73,”

     “74,” “75” or “76” on the UB-04 claim.

    CPT-4 Code Description

    95805 Multiple sleep latency or maintenance of

    wakefulness testing, recording, analysis and

    interpretation of physiological measurements of

    sleep during multiple trials to assess sleepiness

    95807 * Sleep study, simultaneous recording of ventilation,

    respiratory effort, ECG or heart rate, and oxygen

    saturation, attended by a technologist

    95808 * Polysomnography; sleep staging with 1 3

    additional parameters of sleep, attended by a

    technologist

    95810 * sleep staging with four or more additional

    parameters of sleep, attended by a technologist

    95811 sleep staging with four or more additional

    parameters of sleep, with initiation of continuous

    positive airway pressure therapy of bi-level

    ventilation, attended by a technologist

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HCPCS

    Code Description Unit Value

     Z0306 Polysomnography, “By Report”

    analysis, interpretation

    and report without recording

     Place of Service for this code is restricted to outpatient hospitals code “22” and inpatient hospitals code “21” on the CMS-1500 claim

    or to facility type code “13” (hospital – outpatient) and “11” or “12”

    (hospital inpatient) on the UB-04 claim.

    Note: The physician procedure codes for polysomnography cannot

    be billed with CPT-4 code 99070 for coverage of supplies

    because these supplies are already included in the preceding

    facility codes.

    Non-Reimbursable The following codes are not reimbursable when billed with CPT-4

    Components code 94772 (pediatric pneumogram), 95808, 95810, 95811 or with HCPCS code Z0306 or Z7602 by any provider, for the same recipient and date of service.

    CPT-4 Code Description

    82805, 82810 Blood gases with oxygen

    saturation

    94760 Oximetry for oxygen saturation

    92265, 95860 95872 Electromyogram

    92270 Electro-oculogram

    93224 93227 Electrocardiographic monitoring

    94010 94620 Pulmonary function tests

    95816 95827 Electroencephalogram

    The following codes are not reimbursable when billed with HCPCS code Z7600 by any provider, for the same recipient and date of service.

    CPT-4 Code Description

    82805, 82810 Blood gases with oxygen

    saturation

    94760 Oximetry for oxygen saturation

    93224 93227 Electrocardiographic monitoring

    94010 94620 Pulmonary function tests

    95816 95827 Electroencephalogram

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    Evoked Response Medi-Cal covers visual, auditory, somatosensory and central motor Testing evoked response testing.

    Billing for Services When billing for evoked response testing, physicians must use the

    appropriate CPT-4 codes. These codes require split-billing modifiers.

     (For audiologist billing, refer to the appropriate Part 2 Allied Health

    Services provider manual.)

    Test CPT-4 Code

    Auditory 92585

    Central motor 95928, 95929

    Somatosensory 95925 95927

    Visual 95930

    H-reflex 95934, 95936

    Neuromuscular junction 95937

    Reimbursement for CPT-4 codes 95925 95929 and 95934 95937

    is restricted to four times per year for the same recipient by any

    provider. If billed more than four times per year, medical justification

    must be entered in the Remarks field (Box 80)/Reserved for Local

    Use field (Box 19) of the claim or on an attachment to the claim.

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    Neurological Monitoring Neurological monitoring services (CPT-4 codes 95920, 95950, 95951,

     95955, 95958, 95992 and 95999) requires documentation.

     Documentation must indicate the procedure performed and the actual

     time spent monitoring the service. This required information may be

     entered in the Remarks field (Box 80)/Reserved for Local Use field

     (Box 19) of the claim or on an attachment.

    Electromyography (EMG) Any combination of CPT-4 codes 95860 95875 may be reimbursed

    a maximum of four times per year for the same recipient by any

    provider. If billed more than four times per year, medical justification

     must be entered in the Remarks field (Box 80)/Reserved for Local

    Use field (Box 19) of the claim or submitted as an attachment. These

     services are reimbursable only to providers who have a diploma or

    certificate of completion of an accredited neurology or physical

    medicine and rehabilitation residency program.

    Nerve Conduction CPT-4 codes 95900 (nerve conduction, amplitude and

    latency/velocity study, each nerve; motor, without F-wave study),

    95903 (…motor, with

     F-wave study), 95904 (…sensory) and 95905 (motor and/or sensory

    nerve conduction, using preconfigured electrode array[s], amplitude

    and latency/velocity study, each limb, includes F-wave study when

    performed, with interpretation and report) are reimbursable only when

     billed with one of the following ICD-9-CM codes:

    053.11, 351.0 351.9, 352.4, 353.0, 353.1, 354.0 354.9,

    355.0 355.9, 356.0 356.9, 357.0 357.9, 723.4, 724.4,

    728.2, 728.9, 782.0, 951.4, 951.6, 955.0 956.9

    Note: Providers must include the total number of nerves tested on

    the same claim line.

     Any combination of CPT-4 codes in code range 95900 95905

     may be reimbursed a maximum of four times per year for the same

    recipient by any provider. However, reimbursement for CPT-4 codes

     95900, 95903 95905 continues to be restricted to twice a year,

     same provider, when billed with ICD-9-CM diagnosis code 354.0

     (carpal tunnel syndrome). If billed more than four times per year,

     medical justification must be entered in the Remarks field

     (Box 80)/Reserved for Local Use field (Box 19) of the claim or

     submitted as an attachment.

    Billing for Code 95905 CPT-4 code 95905 may not be billed in conjunction with codes

    95900 95904 or 95934 95936.

     This code is split-billed and must be billed with either modifier 26, TC

    or ZS; modifiers 99 and U7 are allowed

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    Electromyography and Electromyography (EMG) and nerve conduction tests are Nerve Conduction Test reimbursable only to providers who have a diploma or a certificate of Certification completion of a neurology or physical medicine and rehabilitation

    residency program accredited by the Accreditation Council of

    Graduate Medical Education (ACGME). Billing providers who are

    actually delivering the service or a group or other entity billing for the

    rendering provider’s service are required to include on an attachment

    to the claim the following exact language:

     Billing provider:

     “I, ( enter name ), certify that I performed the nerve

    conduction test(s) and/or electromyography presently billed

    and that I possess a valid certificate or diploma of my

    satisfactory completion of neurology or physical medicine

    and rehabilitation residency program accredited by the

    Accreditation Council of Graduate Medical Education

    (ACGME).”

    Group or other entity:

     “I, ( enter name ), am an entity billing for the

    performance of the indicated nerve conduction test(s) and/or

    electromyography and certify that, for the professional noted

    as having completed the test(s), ( enter name )

    possesses a copy of a valid certificate or diploma of

    satisfactory completion of neurology or physical medicine

    and rehabilitation residency program accredited by the

    Accreditation Council of Graduate Medical Education

    (ACGME).”

    The rendering provider must sign the self-certification attachment. The

    claim will be denied if either the self-certification or the signature is not

    present.

    Central Nervous System Central nervous system assessments and tests (CPT-4 codes Assessments and Tests 96101 96118) must be billed “By Report.” A copy of the

     report generated as a result of these assessments and tests must be

    attached to the claim.

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