Rewarding H-Reflex Test Coding

Start by marking a difference from F-wave studies.

You might flip Appendix J of the CPT® manual most frequently to review the most number of nerve conduction studies you normally report for definite indications. Don't ignore the next column that addresses H-reflex (or Hoffmann's reflex) studies, though, as these tests have definite considerations to keep in mind while side-stepping denials. Read this neurology billing and coding expert insight on what neurology CPT codes you should use to ensure flawless split night claims.

1. Study Difference Between Tests

H-reflex along with F-wave studies both test the patient's late response reflex and evaluate the whole length of a nerve, but in dissimilar ways. F-waves evaluate motor nerve fiber function along a nerve and are typically conducted grouped with conventional motor nerve conduction studies. H-reflex studies, though, include both the sensory as well as motor nerve fibers as well as test both connections in the spinal cord.

Tip: Your physician's report should classify the nerves assessed with the site of nerve stimulation as well as muscle recording, along with the test characteristics, involving latency. Looking at notations of the tested nerves in your neurologist's documentation will help you decide when you should code for an H-reflex study in place of an F-wave study.

2. Verify Muscle Tested to Determine Code

Once you've decided that you're coding for an H-reflex study, CPT® covers two self-explanatory neurology CPT codes meant for the procedure:

95934 -- H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle

95936 -- Record muscle other than gastrocnemius/soleus muscle.

If you know that the muscle your neurologist tests is the significant to selecting accurate neurology CPT codes.

H-reflex studies generally include assessment of the gastrocnemius/soleus muscle complex in the calf. In rare occurrences, H-reflexes require to be tested in muscles except the gastrocnemius/soleus muscle, for instance in the upper limbs or the intrinsic small muscles located in the hand and foot."

Result: A lot of of your reporting for H-reflex studies will involve 95934 as physicians test the gastrocnemius/soleus muscle complex more regularly than rest of the areas. Validate documentation, though, prior to automatically allocating 95934 for every H-reflex study.

3. Correct Diagnoses

H-reflex studies are very general for the lower extremities, predominantly when the patient goes through radicular pain. The late response studies are regularly used in the evaluation of radiculopathies, plexopathies, polyneuropathies as well as proximal mononeuropathies. In few cases, these studies might be the lone abnormal diagnostic test.

4. Look Out for Modifier Opportunities

The neurology CPT codes for H-reflex studies undertake unilateral procedures, however don't stop with a single code.

H-reflex studies are generally carried out bilaterally as symmetry of responses is an essential standard for abnormality. Bilateral studies are specified when an abnormal response is seen in a unilaterally symptomatic limb or when there is a problem that the response may possibly be abnormal for causes except pathology, for instance advanced age.

Want to have more neurology billing and coding expert tips and know everything about neurology CPT codes? Click here to read the entire article and to get access to our monthly Neurology & Pain Management Coding Alert: Your practical adviser for ethically optimizing coding, payment, and efficiency in neurology and pain management practice

Pin down Common Acronyms to Code More Precisely

Make out how well you understand these abbreviations.

In case the charts you code occasionally seem like alphabet soup owing to specialized acronyms or abbreviations your providers use, it's time to re-acquaint yourself with some common terms to help improve your coding. Read on this expert anesthesia billing service insight and for perfect anesthesia claims and maximized reimbursements.

Here's why: When the physician documents a chart, he doesn't at all times have time to elucidate phrases like "past history" (PH) and "present illness" (PI), however knowing which is which can make a remarkable difference in the correctness of your charts. In case you code a chart thinking that the patient presently suffers from every condition listed as "PH," you'll be certainly coding the wrong diagnoses for the present illness.

Does 'TKA' Mean Visualizing or Replacing?

The physician documents "TKA" in the patient' chart, which could mean "total knee arthroplasty" or "total knee arthroscopy." In arthroplasty, the surgeon repairs or replaces a joint. Through arthroscopy, on the other hand, the surgeon utilizes minimally invasive techniques to look inside the patient's joint to better diagnose problems and probably provide some treatment.

Possibility 1: The right CPT® surgical code meant for total knee arthroplasty is 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]). Code 27447 crosses to anesthesia CPT code 01402 (Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty), which has a base value of 7 units.

Possibility 2: CPT® covers a variety of codes meant for total knee arthroscopy, resting on the detailed procedure. Each choice crosses to anesthesia CPT code 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), which is valued at 4 base units.

Does 'I&D' Point to Clean Up or Incision?

Assume the doctor documents "I and D" on the chart that means he has documented this for both 'irrigation and debridement' as well as 'incision and drainage, This is a different example of two dissimilar types of procedures with two seperate surgical codes, so make certain that you know what your provider means.

Possibility 1: You code irrigation and debridement along with the suitable selection from a huge range of codes, dependent on which level of skin the surgeon reaches. A number of of the options meant for surgical codes cross to either 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) with 5 base units or 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with 3 base unit value. Though, other options send coders to more detailed anatomical codes, so ensure that you do understand which code selection is suitable.

Possibility 2: You code incision and drainage, though, with a choice from 10060-10180. The code descriptors differ in accordance with what the surgeon incised as well sd the level of complexity. Each code crosses to anesthesia CPT codes 00300 or 00400, as the irrigation and debridement procedures.

Want to get more expert advice like this for perfect anesthesia billing service and know everything about anesthesia CPT codes ? Click here to read the entire article and to get access to our monthly Anesthesia Billing Alert newsletter: Your practical adviser for ethically optimizing anesthesia billing service, coding, payment and gaining expertise on anesthesia CPT codes

You Cannot Separately Bill For Starting the IV

Recently, our surgeon carried out an emergency room consult and administered intravenous sedation to perform an incision and drainage of a perirectal abscess. So if I charge for the consult and the procedure, can I code for the IV sedation also?

Well you can only report an intravenous (IV) sedation in addition to an E/M and procedure under certain circumstances. Only a conscious sedation is reportable separately and even that is only in some instances.

If your surgeon carried out conscious sedation, you may be able to bill that with the right documentation and depending on exactly which I&D code you are using. Remember that any code that has the ‘target' symbol in CPT codes includes conscious sedation, which means that you cannot bill the service separately.

If the IV sedation you talked about was conscious sedation for allowable procedure such as 45005 (Incision and drainage of submucosal abscess, rectum), you'll require to document who was monitoring the patient during the case (name and credentials like John Doe, RN). You will also need to document what drug was used and how much as well as the patient's vitals prior to, during, and after the sedation. If you do not have the documentation, you cannot bill for the conscious sedation.

If you cannot bill conscious sedation, you are unlucky for the IV. Beginning an IV is a facility service in the ED; as such you cannot separately bill for starting the IV.