TABLE OF CONTENTS - AAPM&R

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TABLE OF CONTENTS

CPT Coding Basics ..........................................................1National Correct Coding Initiative Edits ....................1

How to Use NCCI Edits ..........................................2 Evaluation and Management ........................................3Integumentary System ................................................ 20

Debridement ......................................................... 20Surgery/Musculoskeletal .......................................... 20

Spinal Injections & Implantable devices ........ 25Surgery/Nervous System ........................................... 24

Epidural Neurolysis/Adhesiolysis .................... 26Percutaneous Discectomy ................................ 29 Discography ......................................................... 29Interlaminar/Epidural Injections ....................... 30Transforaminal/Epidural Injections ................. 32Epiduroscopy/Myeloscopy ................................ 34Annuloplasty ........................................................ 34Spinal Cord Stimulator Implantable Devices . 35Neurostimulators, Analysis-Programming .... 37Peripheral Nerve Neurostimulators ................ 38Intrathecal Pumps ............................................... 39Nerve Blocks .........................................................41Paravertebral Blocks .......................................... 43Facet Joint/Facet Joint Nerve Medial Branch

Block Injections ............................................. 43Sympathetic Nerves ........................................... 44Destruction by Neurolytic Agent (e.g., Chemical,

Thermal, Electrical or Radiofrequency) .... 45Radiology ....................................................................... 50

Fluoroscopy .......................................................... 52Diagnostic Ultrasound ....................................... 52

Medicine/Neurology and Neuromuscular Procedures ................................... 53

Manual Muscle Testing ...................................... 53Range of Motion Testing .................................... 54Electromyography ............................................... 55Cranial Nerve Supplied Muscle Needle EMG

Studies ............................................................. 55Limited Needle EMG Studies ............................ 56Needle EMG Performed with Nerve Conduction

Studies ............................................................. 56Special EMG Studies .......................................... 57Guidance for Chemodenervation ..................... 57Surface EMG ........................................................ 57Nerve Conduction Studies ................................ 57

Intraoperative Neurophysiology ...................... 58Autonomic Function Tests ................................. 58Evoked Potential Studies ................................... 58Reflex Tests .......................................................... 59Neuromuscular Junction Study ....................... 59Unlisted Neurological or Neuromuscular

Procedure ....................................................... 59Motion Analysis and Gait Training ................... 59

Medicine/Physical Medicine and Rehabilitation . 60Modalities – Supervised .................................... 60Modalities – Constant Attendance .................. 60Therapeutic Procedures .................................... 60Active Wound Care Management .................... 61Tests and Measurements .................................. 61Orthotic Management and Prosthetic

Management .................................................. 61Medicine/Acupuncture ............................................... 62

Osteopathic Manipulative Treatment.............. 62Medicine/Chiropractic Manipulative Treatment .. 62Medicine/Moderate (Conscious) Sedation ............ 63Medicare Specialty Codes ......................................... 64Coding for Allied Health Professionals ................... 65Modifiers ....................................................................... 66

Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use ...... 69

Level II (HCPCS/National) Modifiers ................71Special Medicare Modifiers .............................. 72

HCPCS Coding ............................................................... 73Additional Coding Resources .....................................74Exam Templates ........................................................... 75

EMG ....................................................................... 75General .................................................................. 81Musculoskeletal .................................................. 83

Audit Tools ..................................................................... 85Evaluation & Management ................................ 85Musculoskeletal Exam ....................................... 88

Medicare Carrier Advisory Committees and Local Coverage Determinations ...................................... 90

Coding for Services Provided in Ambulatory Surgical Centers ....................................................... 92

Place of Service Codes for Professional Claims ... 93Internet Resources ...................................................... 96Index ............................................................................... 97

Musculoskeletal Injections | 21

2016 AAPM&R CODING COMPANION

Clinical ScenarioA 69-year-old right-handed female presents to the office describing a 6-month history of severe right hand paresthesias in a median nerve distribution. She is beginning to notice hand weakness and incoordination as well as nocturnal awakening secondary to the dysesthesias. A trial of nocturnal splinting, hand therapy and activity modification has not been beneficial.

Impression: Carpal tunnel syndrome

Intervention: Injection of right carpal tunnel with ultrasound-guided injection.

The reportable services include:

CPT/Modifier Description

20526Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel

76942

Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

Medication is billed separately.

A separate written record of the ultrasound visualization procedure should be maintained in the patient record. Many ultrasound codes require the production and retention of image documentation. It is recommended that permanent images, either electronic or hardcopy, from all ultrasound services be retained in the patient record or some other archive, even in those instances where the CPT code descriptor does not specifically require it.

NCCIG0463, J0670, J2000, J2001, 0213T, 0216T, 0228T, 0230T, 10160, 11900, 29075, 29105, 29125, 29260, 29584, 62310, 62311, 62318, 62319, 64400, 64402, 64405, 64408, 64410, 64413, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64479, 64483, 64490, 64493, 64505, 64508, 64510, 64517, 64520, 64530, 64550, 76000, 76001, 77002, 95812, 95813, 95816, 95819, 96375, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99334, 99335, 99336, 99337, 99347, 99348, 99349, 99350, 99374, 99375, 99377, 99378, 99446, 99447, 99448, 99449, 99495, 99496

Medicare Edits20526Global: 000Non-Facility RVU: 2.21Facility RVU: 1.66MUE: 1Allowed Modifiers: 50, 51, 59

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”)

20551 Injection(s); single tendon origin/insertion

Coding TipsModifier 25 (significant, separately identi-fiable E/M service by the same physician) appended to an E/M service to indicate that on the same day as an injection procedure, the physician performed an E/M service that is a significant, separate, identifiable service from the injection. Modifier 25 requires separately identifiable condition and appropriate docu-mentation of medical necessity.

NCCIG0463, J0670, J2000, J2001, 0232T, 10160, 11900, 20526, 20551, 20552, 20553, 29075, 29105, 29125, 29130, 29260, 29405, 29425, 29515, 29530, 29550, 29580, 29581, 29582, 29584, 62310, 62311, 62318, 62319, 64405, 64408, 64410, 64435, 64450, 64455, 64505, 64508, 64510, 64517, 64520, 64530, 64550, 64714, 72240, 72265, 72295, 76000, 76001, 77002, 90781, 95812, 95813, 95816, 95819, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 96375, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99334, 99335, 99336, 99337, 99347, 99348, 99349, 99350, 99374, 99375, 99377, 99378, 99446, 99447, 99448, 99449, 99495, 99496

G0463, J0670, J2000, J2001, 0232T, 10160, 11900, 20526, 20552, 20553, 29075, 29105, 29125, 29130, 29260, 29405, 29425, 29515, 29530, 29550, 29580, 29581, 29582, 29584, 62310, 62311, 62318, 62319, 64408, 64410, 64435, 64455, 64505, 64508, 64510, 64517, 64520, 64530, 64550, 76000, 76001, 77002, 95812, 95813, 95816, 95819, 96375, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99334, 99335, 99336, 99337,

99347, 99348, 99349, 99350, 99374, 99375, 99377, 99378, 99446, 99447, 99448, 99449, 99495, 99496

Medicare Edits20550Global: 000 Non-Facility RVU: 1.68Facility RVU: 1.20Allowed Modifiers: 50, 51, 59

20551Global: 000Non-Facility RVU: 1.73Facility RVU: 1.23Allowed Modifiers: 51, 59

20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)

20553 Injection(s); single or multiple trigger point(s), 3 or more muscles

Coding TipsModifier –59 may no longer be used with CPT® codes 20552 and 20553 to bill for multiple injections.

Many third-party payors will not reimburse for codes 20552 and 20553 if a corresponding J code for medication is not reported.

Clinical ScenarioScenario 1: A 65-year old male presents to the physician’s office at the request of his primary care physician for evaluation of right cervical pain decreased range of motion; physical exam reveals palpable trigger points with twitch response in the right upper trapezius muscle. Given the lack of improvement with previous treatments, including physical therapy, the physician precedes with trigger point injec-tions to the trapezius. Reportable procedures and diagnoses include:

CPT/Modifier Description Diagnosis

9920X-25 New patient visit M54.2 cervicalgia

20552Trigger point injection one/two muscle

M79.1 Myalgia

In this case, the E/M and the injection are separately reportable services because the primary reason for the visit was the E/M service (consultation) and the decision to perform the injection was made following the E/M service. A consultation is not billed because this is a Medicare patient and Medicare no longer recognizes consultation codes. The physician and no other member of the practice has seen this patient before, thus, SA

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Exam Templates | 75


Exam TemplatesEMG

[Patient Name] [MRN] Click here to enter a date. REHABILITATION MEDICINE – NEW OUTPATIENT EMG EVALUATION

CHIEF COMPLAINT HISTORY OF PRESENT ILLNESS

Context Duration Timing Severity Quality Location Modifying factors Associated signs

REVIEW OF SYSTEMS Constitutional No fevers Cardiovascular No swelling in arms or legs Gastrointestinal No incontinence Genitourinary Normal voiding Musculoskeletal No joint swelling/redness/tenderness Integumentary No open wounds Neurological No numbness/tingling/burning Endocrine No thyroid disease Hem/Lymphatic No cancer All/Immunologic No autoimmune disease

PAST MEDICAL HISTORY PAST SURGICAL HISTORY MEDICATIONS ALLERGIES NKDA FAMILY HISTORY Negative for muscle or nerve disease. SOCIAL HISTORY

Tobacco use None Alcohol use None Drug use None Occupation Not working

MUSCULOSKELETAL PHYSICAL EXAMINATION Constitutional: VS BP/HR/Ht/Wt/BMI

Appearance Well developed, well nourished, normal body habitus, no deformities, well groomed Cardiovascular: No swelling, varicosities, edema or tenderness; normal pulses and temperature Lymphatic: No lymphadenopathy in neck or popliteal areas

MSK: Gait & station

Ambulates independently, balance intact

Head & neck Normal inspection, palpation, range of motion, stability, strength and tone Spine, ribs & pelvis Normal inspection, palpation, range of motion, stability, strength and tone

R upper limb Normal inspection, palpation, range of motion, stability, strength and tone L upper limb Normal inspection, palpation, range of motion, stability, strength and tone SA

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Audit Tools | 85


Audit ToolsEvaluation & ManagementSA

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TABLE OF CONTENTS - AAPM&R