Coding and Reimbursement

Current News

• Your Guide to Navigating Reimbursement Issues (March 2013)
• Read the Latest on our Efforts to Improve Your Reimbursement in Capitol Hill Report
• Practical Coding Advice on EMG/NCS (January 2013)
• NCS Cuts Go Into Effect January 1 (December 2012)
• Academy Continues Efforts to Preserve Availability of NCS (December 2012)
• AAN Members: Take Action in Response to the Medicare Cuts for Nerve Conduction and EMG Studies (November 2012)
• 2013 Coding Changes Impacting Neurology (September 2012)
• HHS Final Rule Makes October 1, 2014 Compliance Date for ICD–10 Official (August 2012)
• AAN Position Statement Encourages Recognition of Neurology Subspecialties (August 2012)
• New Specialty Codes Established by CMS for Sleep; Sports Medicine (May 2012)

Sequestration

AMA FAQ on Sequestration

• Medicare FFS claims with dates–of–service or dates–of–discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment.
• Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date–of–service, or the start date for rental equipment or multi–day supplies, is on or after April 1, 2013.
• Beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction BUT Medicare's payment to beneficiaries for unassigned claims is subject to the cut.

The sequestration, resulting from the Budget Control Act of 2011, was postponed by the American Tax Payer Relief Act of 2012. The 2% Medicare cut is part of broader cuts, including automatic spending cuts to national defense and other non–defense budget, to eliminate a total of $1.2 trillion from the federal budget over the next decade.

NCS/EMG Studies

FAQ Document–2013 CPT Coding Changes to Nerve Conduction Studies and EMG

Neurologists should be aware of new values set to go into effect January 1, 2013 for nerve conduction studies and needle EMG add–on codes. The actual payment rates will vary, depending on if the Medicare conversion factor goes up or down compared to 2012. Private health insurers may also adapt similar values.

The AAN worked with the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) to propose higher values for these services, and will continue to work with those societies to advocate for better reimbursement. We are committed to advocating on behalf of our members and helping our members prepare for these changes.

This table shows an approximate change in values. The 2012 scenarios represent typical combinations of billing motor (with and without F–wave), sensory and H–reflex studies. Different combinations would yield different values.

See a breakdown of work RVUs, technical component, and professional component for NCS and EMG services

Read explanation of new coding structure

2013 Medicare Fee Schedule RVU and Dollar Values for Neurology Codes

List of Nerves / 2013 CPT Appendix J

Expanded Appendix J

RUC Survey Process

The American Academy of Neurology is an active participant in the AMA/Specialty Society Relative Value Scale Update Committee (RUC), with a voting member, advisors, and staff attending each meeting. The RUC recommends values for services to CMS, which typically accepts 90% of RUC recommendations.

CMS increasingly evaluates RUC recommendations with a critical eye to further reduce payments as policy dictates.  Successful representation at RUC is critical but not sufficient to guarantee acceptable payment policy. 

The Academy surveys CPT codes that are new, revised, or up for revaluation, and presents recommendations to the RUC. Neurologist participation in these surveys is vitally important. The RUC requires a survey with a minimum of 30 participants. This means 30 responses can influence the valuation of services that thousands of physicians report millions of times over many years. Yet, the AAN often has trouble getting enough responses. In recent surveys, the response rate has been between 2% and 5%.

If you are willing to complete upcoming surveys, please contact lciccarelli@aan.com.

Coding Resources

Visit the Coding Resources page (Member Password Required) to do the following:

• Find answers to frequently asked coding questions.
• Get guidance on how to properly use neurology diagnosis (ICD–9) and procedure (CPT) codes, and more.
• Discover the latest changes in coding and tools to search for the proper codes.
• Find educational resources including webinars, upcoming live courses and coding related policies.

Access the AAN's Coding Resources page. (Member Password Required)

Evaluation and Management

The Coding Subcommittee of the Medical Economics and Management Committee has developed E/M templates for use by neurologists as a means to assist them in coding appropriately for the following:

• Level 1, 2, 3, 4, and 5 new patient/consultation
• Level 1, 2, and 3 initial hospitalization
• Level 1, 2, and 3 subsequent hospital visits
• Level 2, 3, 4, and 5 established patient visits

Find more information on Evaluation and Management.

ICD–10 Resources

The American Academy of Neurology is dedicated to preparing its membership for the implementation of ICD–10 which is mandated by the US Department of Health and Human Services (HHS). Regardless of what stage you are at in your preparation and what your role will be, the AAN can assist with this transition.

Are you where you should be? Check your implementation status with the following ICD–10 preparation timelines for both:

• Small Providers and
• Large Providers

Additional ICD–10 Resources:

• American Association of Professional Coders
• Centers for Medicare and Medicaid Services
• American Health Information Management Association (AHIMA)