Avoid Billing Errors: Neurology Coding Tips from Webill Experts

Neurology billing presents unique challenges due to the complexity of services, evolving coding guidelines, and payer-specific rules. From diagnostic procedures like EEGs and EMGs to time-based services and high-value E/M visits, accuracy in coding is essential to avoid costly claim denials and delays.

At Webill, our billing experts work closely with neurology practices to ensure clean, compliant claims. Below are essential tips to help your neurology practice reduce billing errors and get reimbursed faster.

1. Use the Most Specific Diagnosis Codes

ICD-10 diagnosis codes must reflect the neurology billing guidelines patient’s exact condition. For example, instead of using G40.909 (unspecified epilepsy), use G40.311 (generalized idiopathic epilepsy, intractable, with status epilepticus) if the documentation supports it. Using unspecified codes when more precise options exist often leads to denials or unnecessary audits.

Always confirm that the diagnosis matches medical necessity requirements outlined in payer policies or LCDs (Local Coverage Determinations).

2. Master Neurology CPT Codes

Neurology involves a wide range of procedures, including:

• EEGs (e.g., 95816 for routine EEGs, 95951 for long-term monitoring)

• EMG/NCS (e.g., 95860–95870, 95907–95913)

• Evoked Potentials (e.g., 95930–95940)

Misusing or underreporting these codes can lead to underpayment or denial. Know the rules around bundling and unbundling, especially with EMG and NCS combinations.

3. Accurate Time-Based Coding for E/M Services

Since the 2021 E/M guideline updates, time has become a critical component for office visits. For example:

• Use total encounter time (not just face-to-face) when billing based on time.

• Bill 99417 or G2212 for prolonged services when appropriate, but ensure documentation clearly reflects the time spent and its medical necessity.

Poor time documentation is one of the top reasons neurology claims get downcoded or denied.

4. Modifier Usage: Know When and How

Modifiers help explain unusual circumstances. In neurology, the most commonly used include:

• Modifier 25 – For significant, separately identifiable E/M services on the same day as a procedure.

• Modifier 59 – To distinguish separate procedures or body areas when unbundling services.

Incorrect modifier use can lead to denials or even audits. Make sure documentation supports every modifier applied.

5. Stay Aligned with Payer Policies

Each payer, especially Medicare, may have different policies on what is reimbursable. LCDs and NCDs (National Coverage Determinations) often define which diagnoses justify certain procedures. Before billing:

• Review payer-specific requirements.

• Ensure documentation supports medical necessity.

• Keep up with annual CPT and ICD updates.

Neglecting payer guidelines can result in unnecessary write-offs or appeal processes.

Conclusion

In neurology, even small billing errors can result in major financial losses. Whether it’s choosing the wrong code, applying modifiers incorrectly, or missing a payer’s policy change, mistakes can quickly add up. Webill’s experts recommend a proactive, detail-oriented approach—always double-check codes, maintain clear documentation, and stay current with evolving regulations.

With the right knowledge and systems in place, your neurology practice can avoid billing errors, reduce denials, and improve revenue performance. For expert guidance tailored to your practice, Webill is here to help