Neurology Billing Services

Electrodiagnostic testing is where neurology claims are most often wrong. Nerve conduction codes are chosen by the total number of nerve conduction studies performed, and needle EMG done with nerve conduction studies has its own add-on codes. Payers also cap the units they accept per code, which a busy lab can exceed without noticing. The report has to show each nerve and study counted.

Long-term EEG monitoring was rebuilt into separate codes for setup, technical recording by duration and monitoring level, and professional interpretation by duration. Ambulatory, video and inpatient studies all fall into this structure, so the documentation must show how long the recording ran and how it was monitored.

Botulinum toxin and infusion drugs bring drug billing into the practice. The injection code depends on the condition and site, the drug is billed in units of the HCPCS descriptor, and any amount discarded from a single-use vial is reported with its own modifier for Medicare. These drugs almost always need authorization by indication and dose.

Practices that infuse disease-modifying therapies for multiple sclerosis or other conditions take on buy-and-bill drug risk. Each drug needs an authorization that matches the indication, dose and infusion schedule, administration is billed with the infusion codes for the first hour and each additional hour, and the drug itself is billed in the units of its HCPCS code.

Because the drugs are expensive, a single denied infusion can outweigh weeks of office visits. We verify benefits and authorization before each infusion date, not only the first one, since approvals expire and plans change at the start of the year.