Introduction

Neurology deals with nervous system disorders. The nervous system controls all the body functions. It has two main parts: the brain and spinal cord, which collectively make up the central nervous system. Neurology medical billing is a comprehensive process where neurologists provide services and seek reimbursement from insurance companies. It is considered vital for neurology because it directly impacts the financial health of a hospital. Like neurology diagnoses and treatments, neurology medical billing can be complicated because of the inclusion of CPT codes and Modifiers that are used for submitting reimbursements from insurance providers. In the article, the challenges faced by the neurology in terms of submitting clean claims will be discussed in detail. Meanwhile, the commonly used CPT codes and best strategies to submit clean and accurate claims will also be conferred in detail.

Understanding Neurology Medical Billing and Coding

The primary goal of neurology medical billing is to ensure fair compensation for providers. To determine fair payment, it becomes imperative for neurologists to rely on Evaluation and Management (E/M). In addition, they must also be able to understand the Medical Decision Making (MDM) systems. E/M coding assesses the history of previous examinations and decision making in patient meetings. On the other hand, MDM focuses on the complexities of the decision making process. Both of these systems help in determining the appropriate reimbursement for all the services provided by a Neurologist.

Digging deeper, it can be found that the E/M services are classified into five different levels, starting from Level 1 (refers to simple) and reaching Level 5, which refers to the most complex one. Similarly, MDM can also be categorized into four phases, starting from straightforward. It is then followed by a low complexity phase, a moderate complexity phase, and reaches high complexity.

After determining these levels, the medical billers can convert each service into industry standard codes. The main medical code sets used are the Current Procedural Terminology (CPT) and the International Classification of Diseases, Tenth Revision (ICD 10). Digging deeper into the ICD 10, it can be found that it is further divided into two categories. The first one is the Procedural Coding System, i.e., ICD 10 PCS, which is used in inpatient and hospital settings. The second is the Clinically Modified, i.e., ICD 10 CM, which is used for clinical and outpatient settings. Read More...