Webill’s Quick Guide: Neurology Coding Tips for Clean Claims
In the specialized world of neurology, accurate medical coding is essential for clean claims, timely reimbursements, and avoiding denials. Neurology involves complex diagnostic procedures, time-based services, and evolving guidelines—making precision a must. Webill’s quick guide offers focused tips to help neurology practices code correctly and get paid faster.
1. Understand Key Neurology-Specific Codes
Neurology uses a wide array of CPT codes, especially for:
EEG (Electroencephalogram): Differentiate between routine (95816) and long-term monitoring (95951).
EMG/NCS (Electromyography/Nerve Conduction Studies): Be aware of bundling rules (e.g., 95860–95870, 95900–95904).
Evoked Potentials: Know when to report visual, brainstem, or somatosensory studies.
Stay current with yearly CPT updates to ensure accuracy.
2. Time-Based Services Require Detailed Documentation
For services like:
Evaluation and Management (E/M) Visits
Prolonged Services (99417 or G2212)
… document total face-to-face or neurology billing guidelines total encounter time accurately. This is especially critical under the 2021 E/M guidelines for office visits, which rely heavily on time or medical decision-making.
3. Use Modifiers Appropriately
Modifiers tell payers more about the service provided. Common examples in neurology:
Modifier 25: Used with E/M codes when a significant, separately identifiable service was performed on the same day as a procedure.
Modifier 59: For distinct procedural services, especially useful when unbundling NCS/EMG combinations.
Misuse can trigger denials or audits, so use only when medically necessary and clearly documented.
4. Link the Right Diagnosis Codes
Always link procedures to the most specific and medically necessary ICD-10 codes. For example:
G40.909 – Epilepsy, unspecified, not intractable
G43.909 – Migraine, unspecified, not intractable
Avoid unspecified codes when more detailed ones are available, and ensure diagnosis supports medical necessity.
5. Watch for Local Coverage Determinations (LCDs)
Medicare and some commercial payers issue LCDs that define what diagnoses justify certain services. Reference LCDs before billing for high-cost studies like:
EEGs
Sleep studies
Nerve conduction testing
Failure to comply with LCDs can result in non-covered claims.
Conclusion
Neurology coding is intricate, but mastering it is key to clean claims and financial stability. By applying these practical tips—staying updated on CPT/ICD changes, documenting precisely, using modifiers wisely, and aligning with payer policies—your neurology practice can significantly reduce denials and improve cash flow. Webill is here to support you with expert guidance and tools tailored to specialty billing success.