Coding Subcommittee of MEM: Our Activities and Accomplishments

January 7, 2009

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By Peter D. Donofrio, MD, FAAN

Three Areas of Focus

The Coding Subcommittee of the Medical Economics and Management Committee focuses on three areas:

  • Diagnosis coding (ICD-9-CM and ICD-10-CM)
  • Evaluation and Management (E/M) coding for office encounters, inpatient admissions, and consultations
  • CPT® coding for procedures performed by neurologists such as EMG, nerve conduction studies, EEG, sleep studies, neurostimulators, botulinum toxin injections, and intraoperative monitoring

In these areas, the Coding Subcommittee interacts with organizations that create and modify policies which affect coding, such as the American Medical Association (AMA), the National Center for Health Statistics (which maintains ICD-9-CM and ICD-10-CM in the United States), the Centers for Medicare & Medicaid Services (CMS), and private insurance companies.

Core Activities

One of our primary responsibilities is to educate AAN members. We provide speakers for practice management courses given at the AAN Annual Meeting and the Fall and Winter Regional Conferences. Our goal is to teach accurate coding for neurologic diseases, E/M encounters, and neurologic procedures. Members of the Coding Subcommittee are often asked to speak at state neurologic societies on similar topics. We also use electronic media to share our expertise. In November 2008, we presented a national telecast on accurate E/M coding after which members could contact the speaker with specific questions. Web-based courses are being explored.

The Coding Subcommittee recently created E/M templates for outpatient and inpatient encounters that demonstrate how to properly code for the different levels of service that can be billed for these visits. The templates can be downloaded from AAN.com in Microsoft Word and PDF formats. Templates for nursing home visits will be available in the near future.

Members of the Coding Subcommittee collaborate with the Practice Improvement Subcommittee of the Practice Committee to create educational case studies that expand on AAN practice guidelines. So far, we have addressed diabetic neuropathy, trigeminal neuralgia, parkinsonism, headache, botulinum toxin injections, benign positional vertigo, and falls. In each case study, we contributed sections on accurate disease coding, selection of E/M codes, and coding for neurologic procedures matched to the clinical details of a hypothetical patient with that condition.

The Coding Subcommittee was instrumental in adding new ICD codes that are particularly useful to neurologists, covering diagnoses such as traumatic brain injury, myoclonus, inclusion body myopathy, myotonia, headaches, and seizures. Representatives of the subcommittee propose new CPT codes for technology, procedures, or maneuvers for which codes have not previously been assigned. At recent CPT meetings, we successfully presented new codes for tremor analysis and the canalith repositioning technique.

Several members of the Coding Subcommittee participate in quarterly meetings of the Relative Value Update Advisory Committee (RUC) of the AMA. The RUC sets the physician work values for the full spectrum of medical procedures and E/M encounters. Newly proposed services and procedures undergo rigorous scrutiny by members of different medical specialties before their work and practice expense values are determined.

Participation in the Process

The Medicare Fee Schedule and Outpatient Prospective Payment System change yearly. The Coding Subcommittee reviews them and comments as needed.

If you are interested in coding for neurologic diseases, services, and procedures, we'd like to speak with you about contributing to our work. Please contact Amanda Becker at abecker@aan.com for information on how to become involved with this important AAN subcommittee.

Author Disclosure

Within the past 24 months, Dr. Donofrio has performed consulting for Talecris Biotherapeutics as well as serving on the editorial board of Muscle & Nerve. In addition, he has served as a consultant in medical legal cases.