The human nervous system is an extensive communication network of neurons and electrical signals that controls activities ranging from thinking to muscle contractions. Neurology is the branch of medicine that focuses on diagnosing system disorders, and as such, neurology coding provides the appropriate medical codes that accurately reflect the essence of treating such disorders. It is essential for both patient management and practice management.
This guide provides you with a detailed overview of the neurology coding process and arms you with all the information you need to know regarding neurology coding. Regardless of your level of experience, this guide serves as your road map to success in the medical coding field.
Understanding Neurology Coding
Neurology coding is the specialty of converting all the complex details of neurology into code that insurance companies and government organizations can comprehend. It is not just assigning arbitrary numbers; it is an important process in the medical billing cycle where comprehension is important. Coders understand the nuances of patient interactions in neurology practices, including detailed assessments, complex processes, and unique diagnoses.
Neurology coding helps to ensure that the practice is reimbursed correctly through accurate coding using two systems: CPT for services and ICD-10-CM for diagnoses. This way, they can continue providing excellent care to patients with neurological diseases and disorders.
Coding Procedures in Neurology: A Step-by-Step Guide
Neurology coding entails the following procedure to meet the description of the services offered. Here’s a breakdown of the steps involved:
Gather Information
Assess the notes that the physician made regarding the patient’s medical history, events during the time they met, and procedures done.
Identify the Service
Find out the service being offered by a neurologist for the specific ailment. This would include any E/M services, such as consultations and diagnostic procedures like EEG or EMG.
Select the CPT Code
Consider the Current Procedural Terminology (CPT) codebook and determine the correct code that comes closest to describing the performed service. This is best done based on the type of procedure, the time taken and the general difficulty that any particular procedure is bound to exhibit.
Evaluate Modifiers (if applicable)
CPT codes may contain modifiers that need to be added in order to report information that is not captured in the base code. These modifiers could refer to the side of the body, the LOS, or time-sensitive services, or new or upstream services.
Link to the Diagnosis
Find the ICD-10-CM code that corresponds to the chosen CPT code and indicates the diagnosis of the patient.
Verification and Documentation
When assigning diagnosis codes, go over all of them and check if they match the information that the physician entered. Make detailed documentation with the ICD-10 codes to support decisions taken in the coding process.
Common CPT Codes for Neurology Billing and Coding
Neurology employs numerous CPT codes, depending on the nature of the service provided in the procedure. Here’s a glimpse into some commonly encountered CPT code categories:
Evaluation and Management (E/M) Services (99201-99499):
It involves office visits, consultations, and other outpatient services that may have been offered by the neurologist. The kind of code used depends on variables such as the amount of time the physician spends in the medical decision-making process and the amount of time spent with a patient.
Electroencephalogram (EEG) Procedures (95812-95836):
These codes include several EEG tests useful in evaluating brain functionality. These can vary from basic EEG (95812) to complex procedures such as sleep EEG (95819) or evoked potential studies (95925-95937).
Electromyography (EMG) Procedures (95860-95872):
These codes refer to procedures that assess muscle and nerve performance by utilizing electrical current. They include needle EMG (95860) and studies of specific nerve pathways (95867).
Nerve Conduction Studies (NCS) (95905-95913):
These codes include procedures that aim at determining the rate and efficiency of movements of electrical impulses in nerves. It can be used in diagnosing different disorders of the nerves.
Other Neurology and Neuromuscular Procedures (95990–95999):
This category covers a wider range of less frequent and less invasive procedures in neurology, which could include, for instance, a lumbar puncture or injections of botulinum toxin to relieve muscle spasms.
Sleep Medicine Testing and Long-term EEG Procedures (95700–95811):
This category deals with procedures used in the screening and diagnosis of sleep disorders. Some of these codes include: sleep study (95780), also known as polysomnography, and multiple sleep latency tests (95786).
Electrocorticography (ECoG) (95829–95836):
These codes denote procedures where electrodes are applied directly to the surface of the brain with the goal of recording electrical activity. This is usually done for the purposes of monitoring epilepsy or for a presurgical assessment.
Range of Motion Testing (95836–95857):
Although these codes are not specific to neurology, they can help the clinician evaluate the joint flexion that can be related to neuropathy.
Ischemic Muscle Testing Procedures and Guidance Procedures for Chemo denervation (95873–95887):
It comprises procedures that help assess the blood flow to muscles and procedures targeting the nerve impulses for pain control.
Autonomic Function Testing Procedures (95919–95924):
These codes refer to tests that are employed for the evaluation of the autonomic nerve, which regulates the involuntary actions of the body such as the heartbeat and gastrointestinal systems.
Intraoperative Neurophysiology Procedures (95940–95941):
These codes list those procedures that are done intra-operatively to screen the workings of the nervous system.
Motion Analysis Procedures (96000–9600):
This category comprises procedures employed in evaluating kinetic policies, which can be useful in the diagnosis of neurological disorders of movement.
Functional Brain Mapping (96020):
This code refers to a specific technique that is commonly utilized in evaluating the efficiency of the brain prior to surgery.
| Category | Description | Example Codes |
| E/M Services (99201-99499) | Office visits, consultations | 99215: Established patient, extended visit |
| EEG Procedures (95812-95836) | Brain function tests | 95812: Basic EEG |
| EMG Procedures (95860-95872) | Muscle & nerve performance tests | 95860: Needle EMG |
| Nerve Conduction Studies (NCS) (95905-95913) | Nerve impulse evaluations | 95905: Motor NCS of one extremity |
| Other Neurology Procedures (95990-95999) | Less common procedures | 95990: Lumbar puncture |
| Sleep Studies (95700-95811) | Sleep disorder diagnosis | 95780: Polysomnography |
| Electrocorticography (ECoG) (95829-95836) | Brain electrical activity recording | 95830: ECoG monitoring |
| Range of Motion Testing (95851-95857) | Joint flexion assessment | 95857: Multiple joint range of motion testing |
| Ischemic Muscle Testing (95873-95887) | Blood flow and pain control procedures | 95875: Ischemic muscle exercise test |
| Autonomic Function Testing (95919-95924) | Involuntary body function evaluation | 95921: Quantitative sudomotor axon reflex test |
| Intraoperative Neurophysiology (95940-95941) | Nervous system function during surgery | 95940: Somatosensory evoked potential monitoringpen_spark |
| Motion Analysis Procedures (96000-96004) | Movement disorder evaluation | 96000: Gait analysis |
| Functional Brain Mapping (96020) | Brain function assessment before surgery | 96020: Functional brain mapping |
Common ICD10 Codes for Neurology Coding
Here’s a glimpse into some commonly encountered ICD-10-CM code categories used in neurology coding:
Central Nervous System Infections (G00-G09): These codes include all bacterial, viral, and parasitic infections of the brain, the cord, and the membranes. These diseases include meningitis (G00), encephalitis (G05), and brain abscess (G09.1).
Degenerative Diseases of the Nervous System (G90–G99): Distal acidosis refers to a group of diseases in which the function of the nerves gradually decreases. Some of the commonly seen ICD-10 codes are Alzheimer’s disease (G30, Parkinson’s disease (G20, and amyotrophic lateral sclerosis (ALS) (G12.2.
Epilepsy and Other Seizures (G40): These codes signify different kinds of seizure disorders, such as the generalized tonic clonic seizures (grand mal seizures) that are coded to G40.1 and absence seizures (petit mal seizures) that are coded to G40.5.
Cerebrovascular Diseases (G45): This category involves the conditions that affect stroke, for instance, ischemic stroke (ICD-10 code I63), hemorrhagic stroke (ICD-10 code I61), and transfert ischemic attack (TIA) (GG45.9).
Inflammatory Disorders of the Central Nervous System (G03, G35): These codes refer to autoimmune diseases that may affect the human body by identifying the system as an enemy and attacking it. Some of them include multiple sclerosis, which belongs to G35, while optic neuritis is categorized under G03.0.
Headaches and Migraines (G43): This category includes different types of headaches, for example, migraine without aura (G43. 001) and migraine with aura (G43. 101).
Neuromuscular Disorders (G70-G73, Myopathies-GG71): This includes diseases of the muscles and nerves like myasthenia gravis code G70.0 and muscular dystrophy code G71.0.
Congenital Malformations of the Nervous System (Q00-Q07): These codes relate to neural tube defects, which are congenital conditions: spina bifida (Q 003) and anencephaly (Q 000), respectively.
| Condition | ICD-10 Code | Example |
| Brain Infection | G00-G09 | Meningitis (G00.1) |
| Nervous System Degeneration | G90-G99 | Alzheimer’s (G30.0) |
| Seizures | G40 | Grand mal seizure (G40.1) |
| Stroke | I60-I69 | Ischemic stroke (I63.0) |
| Autoimmune Nervous System Disease | G03, G35 | Multiple Sclerosis (G35) |
| Headaches | G43 | Migraine without aura (G43.001) |
| Muscle & Nerve Disorders | G70-G73 | Myasthenia gravis (G70.0) |
| Birth Defects (Nervous System) | Q00-Q07 | Spina bifida (Q00.3) |
Neurology Coding Guidelines and Regulations
Neurology coding is not just a process of assigning codes but requires a deep understanding of them. Knowledge of rules and regulations that must be followed is important so that a practice can avoid violations and also be able to claim all the possible reimbursements it is entitled to. Here’s a breakdown of some key areas to consider:
Medicare Regulations
The Centers for Medicare and Medicaid Services (CMS) implement particular guidelines for coding the medical services delivered to Medicare consumers. It is crucial to comprehend these regulations, especially for practices dealing with a large number of Medicare patients.
E/M Coding Guidelines: CMS has set certain rules that dictate how to choose Evaluation and Management (E/M) codes depending on factors such as medical decision-making, history, and examination. These guidelines help doctors promote consistency and standardization while coding office visits and consultations that bear relation to neurology.
Place of Service Codes: Medicare has adopted place of service codes, which refer to the place where a certain service was delivered. Getting these codes correct is important for billing since Medicare pays differently for services delivered in different settings (e.g., hospital outpatient departments compared with physician offices).
HIPAA Compliance
HIPAA is the Health Insurance Portability and Accountability Act that protects the privacy of patients and provides guidelines for the use and release of PHI. It is important that medical coders respect HIPAA rules over handling patient details in the course of coding.
Coding Updates
Analyzing medical records that pertain to patients with neurological disorders requires understanding two coding systems, CPT and ICD 10 CM, which are revised annually. Being aware of these updates is important, as it helps a health facility apply the most appropriate and updated code for billing. These updates can be found on the websites of healthcare professional organizations such as the American Medical Association (AMA) or the Centers for Medicare and Medicaid Services (CMS).
Payer Specific Requirements
Generally, Medicare has standard regulations on coding, but individual insurance companies can have extra regulations. The coding standards that have been set must be appreciated and followed by anyone who is working with any of the payers that a practice may deal with.
To financially sustain your neurology practice, it is crucial to remain knowledgeable of the above-highlighted regulations and be committed to practicing accurate coding systems, as this helps in obtaining proper reimbursement while abiding by the legal and ethical requirements of the healthcare system.
Mistakes to Avoid in Neurology Coding Process
Neurology coding is particularly complex due to the detailed results that have to do with the complex functioning of the human nervous system. Here, we delve into specific errors that can trip up even seasoned medical coders in this specialized field:
Misinterpreting Neurological Exam Findings
Some neurological tests always have peripheral features of muscle power, reflexes, and coordination. This can be attributed to errors within the documentation or simply because a coder is not knowledgeable about neurological terms. Consequently, either the wrong E/M code is assigned, depriving the practitioner of reimbursement for a complex neurological examination, or the nature and severity of the patient’s condition cannot be adequately captured with the proper ICD-10-CM code.
Incorrect Modifier Application in Neurology
Many neurology procedures comprise certain terms like laterality, which means either the left or right side or a certain anatomic site. Choosing the wrong location indicator for laterality (such as modifier 52 for left-sided procedures versus modifier 53 for right-sided procedures or for the opposite side), as well as leaving out a required location identifier, may change the meaning of the CPT code and result in a denied claim.
Upcoding or Undercoding Evaluations and Management Services in Neurology
One very relevant risk is the potential distortion of the neurological assessment (upcoding) due to the lengthy time such assessments may take. However, this is unethical, and it may lead to audits and penalties. On the other hand, undercoding complex neurological consultations because the provider failed to assess the level of medical decision-making involved would have detrimental effects on the practice’s revenue. It is important that neurology coders pay close attention to history, examination, and medical decision-making as laid down in the E/M coding guidelines.
Unbundling Procedures Specific to Neurology
Neurology comprises several tests that may fall under one HCPCS code. For example, an EMG study can encompass needle EMG and nerve conduction studies. Therefore, when billing, it is prohibited to unpack these procedures to submit different codes for each and every one since it will be considered fraud.
Outsource Your Neurology Coding to a Reliable Medical Billing Company
Mastering the neurology coding process can indeed be quite a challenge. Outsourcing to a medical billing company like Medheave could be one of the defining business development strategies for your neurology practice. Medheave’s experienced and certified coders, familiar with the coding of neurology procedures, guarantee proper, efficient, and maximum reimbursements. This saves your neurologists’ working time for patients’ treatment, while Medheave’s successful concept enhances the flow of cash and minimizes formalities. It is recommended to take advantage of a free consultation with Medheave to discuss how this company’s solutions can help your practice succeed.
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