Neurology Billing Services: A Comprehensive Guide

The human nervous system is a masterpiece of intertwined connections and electrical impulses. However, for neurologists who are juggling between the demanding medical diagnosis and the treatment of neurological disorders, the administration task of neurology billing can be equally complex and sometimes a headache.

This in-depth guide covers a variety of details regarding neurology billing services, proposes practical approaches, and provides useful strategies for improving efficiency, enhancing accuracy, and maximizing reimbursement for neurology practices.

Commonly Used CPT® and ICD-10-CM Codes in Neurology Medical Billing

Here is a list  of commonly used codes in neurology billing:

CPT® Codes

95851-95857: These codes represent Range of Motion Testing procedures used to assess a patient’s joint mobility.

95905-95913: These codes represent Nerve Conduction Studies used to evaluate nerve function.

95812-95836: These codes encompass various Electroencephalogram (EEG) procedures, ranging from routine EEGs to more complex studies like evoked potentials

95860-95872: This range covers Electromyography (EMG) procedures used to assess the health of muscles and nerves.

95925-95937: These codes represent Evoked Potentials and Reflex Testing procedures used to evaluate the nervous system’s response to stimuli.

95970-95984: This range covers Neurostimulators Analysis-Programming Procedures used to manage implanted stimulators for conditions like Parkinson’s disease.

95938-95941: This range covers Intraoperative Neurophysiology procedures performed during surgery to monitor the nervous system’s function.

95905-95913: These codes represent Nerve Conduction Studies used to evaluate nerve function.

95954-95726: These codes represent Special EEG Testing procedures used for more complex evaluations beyond routine EEGs.

96020-96020: This code represents Functional Brain Mapping, a specialized procedure for evaluating brain function.

ICD-10-CM Codes

G00-G99: This range encompasses neurological diseases and conditions. Some examples include:

G40: Epilepsy

G35: Multiple Sclerosis

G20: Parkinson’s Disease

G10: Huntington’s Disease

I: Anoxic Brain Damage, not elsewhere classified

0: Muscular Dystrophy

G61: Intraspinal Abscess And Granuloma

Complexities in Neurology Billing

Here’s a breakdown of the complexities in neurology billing:

Complexities in Neurology Billing

Intricate Diagnoses

The neurological conditions are widespread and have several clinical presentations, making them complex in both detection and management. Correctly translating those highly complex neural system processes into precise CPT (current procedural terminology) codes requires a very sound understanding of the nervous system as well as the subtleties associated with the coding guidelines. 

One slipped detail can lead to inaccurate billing and challenging reimbursement. Thus, the health record needs to be highly accurate.

Evolving Coding Requirements

The health care coding environment is becoming more and more dynamic, with newly released codes. The handling of these frequent changes is of utmost importance not only for the successful management of neurology practices but also for minimizing both the delays and the financial strain.

Detailed Documentation Demands

Neurology billing heavily relies on precise and accurate documentation of the patient’s history, physical examination, and medical decision-making process. It involves an in-depth description of these events. Failure to provide essential information could be a reason for bills being denied while at the same time prevents the coding from falling under the selected billing codes. 

Multiple Procedures and Services

Neurological care is typically a multi-faceted procedure ranging from regular electroencephalogram (EEG) to intricate nerve conduction studies. In order to correctly bundle these services and make up the appropriate modifiers, one must fully know and have the ability to transform these regulations into clear, specified codes for the insurance companies. This complexity creates errors and causes a reimbursement delay.

Rapid Technological Advancements

The technological and diagnostic field of neurology is expanding, with new technologies and modalities developing rapidly. However, an alternate procedure system may not be coded yet, which  further complicates the billing process. This brings about a situation whereby the collection of insurance claims is hampered until the correct codes are implemented.

Such factors, when put together, increase rates of claim rejections, reduce efficiency, and create financial difficulties for neurological practices.

Benefits of Outsourcing Neurology Billing Services

The benefits of outsourcing neurology billing services are listed below:

Benefits of outsourcing Neurology billing services

Reduced Denial Rates

The complex nature of neurology billing invites a higher risk of denials than other specialties. The average denial rate for neurology services requested at the national level is 12%, which poses a worrisome prospect. Medical billing companies have certified coders who possess an in-depth knowledge of neurology-specific coding rules. They can correctly encode diseases like demyelination (G35) or muscular dystrophy (G86) into an appropriate CPT code. It reduces errors while improving billings for procedures like EEGs (95812-95836), EMGs (95860-95872), and Nerve Conduction Studies (95905-95913).

Streamlined Neurology Billing Workflows

Medical billing companies use well-developed workflows that were designed for the complexity of neurosurgical billing. This goes beyond assigning appropriate codes to services like evoked potentials and EEGs. It also includes designating the proper modifiers for complex procedures like intraoperative neurophysiology (95938–95941). This simplified process eliminates errors while enabling a speedy time period for claim submission.

Reduced Burden for Neurology Staff

In the neuroscience field, the billing services of each clinic are mostly labor-intensive due to the responsibilities that require inspection. This would mean that the neurologists have more time for their staff and themselves. It allows them to focus on core competencies like:

  • Accurate diagnoses and treatment decisions that involve the historic patient consultation.
  • Procedures like nerve blocks or intrathecal pain pumps  performed on patients with neurologic problems.
  • Outlining a complex medical diagnosis or situation for patients in a communicable way.

Staying Ahead of Evolving Neurology Coding

The medical billing environment constantly experiences changes, with the major focus being on the new coding updates and regulatory codes specific to neurology. The medical billing organizations are keeping up with the changes (i.e., functional brain mapping (96020) or the latest neurostimulator analysis techniques (95970)) so that your practice meets the government standards that have been set in place. This prevents problems such as penalties, which usually occur due to outdated billing practices.

Cost-Effective Solution

Outsourcing billing services could be helpful to neurology practices in terms of expenses. Neurology medical billing is a very skilled job that requires expertise, access to the best technology, and an investment in training healthcare billing staff. However, instead of hiring and training dedicated billing staff, you can use an already established medical billing company that comes with the necessary infrastructure and technology specifically designed for neurology billing. This means that there is a huge amount of money that can be saved in the future.

Focus on Exceptional Patient Care

This disburdening process of billing work reduces the time of neurologists and staff so that they can concentrate more on patient care than their work. This allows for:

  • Improved patient outcomes through an emphasis on correct diagnosis and therapy plans.
  • Patient satisfaction takes off because of transparent communication and minimal waiting.
  • A successful neurology practice that is built from the ground up on quality care and financial stability.

Summarizing, we can say that outsourcing neurology billing permits various advantages that exactly meet the specific needs of neurology practices. From the elimination of denials and better workflows to lowered administrative burden and cost effectiveness, partnering with a comprehensive billing company enables neurologists to efficiently run their practice, bring in more revenue, and subsequently focus on providing the best possible patient care.

How Medheave Medical Billing Company Can Help Neurologists?

Here’s how Medheave Medical Billing Company can be your guide and partner in navigating this challenging landscape:

How Medheave Medical Billing Company Can Help Neurologists

Deep Understanding of Neurology-Specific Coding

Our highly skilled team, composed of certified coders with an extensive background in neurology coding requirements, undeniably offers top-notch coding services. The company offers easy translation of complicated diagnoses such as demyelinating diseases (G35) or muscular dystrophy (G86) into their CPT counterparts. This makes sure that you get an appropriate reimbursement for EEGs (95812-95826), EMGs (95859-95862), and Nerve Conduction Studies (95905-95913).

Streamlined Workflows for Neurology Billing

Medheave not merely follows well-established workflows but rather creates a much more mod-flourish scheme to cater for the peculiarities of neurology billing. We are experts in matching the services with the corresponding code and utilizing the appropriate modifiers for complex procedures. This thereby reduces errors and causes better and faster claim submissions that result in accelerated reimbursements of hospital bills.

Reduced Administrative Burden for Neurologists

We realize that neurologists are short in time with their vital responsibility of treating diseases. With the support of Medheave’s billing process, you and your team members are likely to have a more manageable task force with decreased in-house billing responsibilities. This allows you to focus on core competencies like:

  • In-depth patient interactions are necessary to precisely determine the diagnosis and treatment management processes so as to allow for flawless coding and reporting.
  • Conducting neurological procedures like nerve blocks and spinal infusion pumps, which have proven to be very helpful for patients with chronic pain.
  • Informing patients concisely and simply about the complex diagnoses.

Staying Current on Evolving Neurology Coding

The medical billing environment is dynamic; new coding updates and regulatory changes (which directly affect neurology) are being implemented. Medheave keeps up with these and other changes in order to safeguard your practice in compliance with CPT codes, including diagnosis by functional brain mapping (96020) or analysis of the latest kind of neurostimulator (95970-95984). This helps in avoiding the associated penalties of outdated billing practices.

Maximized Reimbursements

Our experience in neurology-dedicated coding with a high level of detail guarantees fewer claim denials. Hence, you will get higher repayment rates.

Improved Revenue Cycle Management

The Medheave practice uses practical revenue cycle management strategies to ensure full payments within the specified time and maximize cash flow. Such financial stability requires you to continuously reinvest in patient care and practice development.

Dedicated Account Management

We assign to your practice a specific manager responsible for the provision of services, and he is your connection with our team of billing professionals. The reason behind this is the maintenance of effective communication and our ability to grasp concrete details about your requirements.

Technology Tailored for Neurology Billing

Medheave utilizes billing software that is specifically designed to simplify the difficulties associated with neurology billing. This results in timely claim processing and short response times as well, improving your practice’s data security.

Scalable Solutions

Our billing solutions are able to grow with your practice of neurology. With this, you have support all the time, whether you are a small clinic or a large-scale practice.

With Medheave as your partner, your physicians will have a team of experts who know the delicate nuances of neurology billing. Let us give you some relief so that you can pay attention to giving extraordinary patient care while making sure that your office is running smoothly. Contact us for further details. 

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