In the ever-evolving landscape of healthcare, medical coding changes are not uncommon especially in specialized fields like neurology. As the demand for neurological services increases, so does the complexity of coding guidelines, compliance requirements, and reimbursement rules. Staying updated on key neurology coding changes is essential for physicians, medical coders, and billing teams to ensure accurate documentation, avoid denials, and maximize reimbursement.

This article highlights the most important neurology coding updates every physician should be aware of in 2025 and beyond.

Why Neurology Coding Accuracy Matters?

Neurology is a highly specialized field that deals with complex diagnoses and procedures related to the brain, spinal cord, nerves, and muscles. Accurate coding is crucial for:

• Capturing the complexity of patient care
  
• Ensuring compliant billing practices
  
• Avoiding claim denials and audits
  
• Facilitating data analysis for clinical research and outcomes
  

Given the high cost and technical nature of neurological tests like EEGs, EMGs, and sleep studies, coding mistakes can be costly.

CPT Code Updates in Neurology

1. Evaluation and Management (E/M) Services Overhaul

One of the most significant changes affecting all specialties, including Neurology, is the continued refinement of E/M coding guidelines. These updates focus on:

• Medical Decision Making (MDM) as the primary factor
  
• Time-based coding for visits
  
• Elimination of history and physical exam as key elements

Neurologists often manage chronic and complex conditions such as epilepsy, Parkinson’s disease, multiple sclerosis, and dementia. Understanding how to correctly document complexity in MDM is crucial for selecting the right level of E/M service (e.g., CPT 99213 vs. 99215).

2. Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM)

With the rise of telehealth and remote care, neurology practices increasingly use RPM and RTM services to monitor patients with migraines, epilepsy, and neurodegenerative conditions. Relevant CPT codes include:

• 99453:  Initial set-up and patient education
  
• 99454: Device supply with daily recording
  
• 98975 to 98978: Remote therapeutic monitoring codes for cognitive behavioral therapy (CBT), respiratory, and musculoskeletal systems

Understanding the documentation and billing requirements for these codes is vital, including frequency limits and time thresholds.

3. New Codes for EEG and EMG Interpretation

Recent changes have added or revised CPT codes for electroencephalography (EEG) and electromyography (EMG). These include:

• 95700–95726 – Long-term EEG monitoring codes replaced older codes (e.g., 95827)
  
• These codes differentiate based on:
  
  • Duration of monitoring
    
  • Whether the provider is present or reviewing remotely
    
  • Inclusion of video monitoring
    
  • Type of reporting (technical vs. professional)

It’s essential for neurologists to accurately document the components of EEG studies to ensure appropriate code selection.

ICD-10-CM Code Changes for Neurology

4. Updated ICD-10 Codes for Epilepsy and Seizures

New and revised codes under G40 (epilepsy and recurrent seizures) offer better specificity. For example:

• G40.A01:  Childhood absence epilepsy, intractable
  
• G40.B11: Juvenile myoclonic epilepsy, intractable with status epilepticus

Physicians must document seizure type, intractability, and presence of status epilepticus to ensure correct code selection.

5. Parkinson’s Disease Coding Expansion

The updated codes for Parkinsonism (G20–G26) now allow differentiation between:

• Idiopathic Parkinson’s disease
  
• Secondary parkinsonism (e.g., drug-induced)
  
• Parkinsonism due to other diseases

This added specificity helps improve patient outcome tracking and research.

6. New Codes for Functional Neurological Disorders

Functional neurological symptom disorders (formerly known as conversion disorders) now have ICD-10 codes under F44.4–F44.9, such as:

• F44.4:  Functional motor disorder
  
• F44.6:  Functional sensory disorder
  

This reflects the growing recognition of functional neurological symptoms in clinical practice.

Key Documentation Tips for Neurologists

Accurate and detailed documentation is the foundation of proper coding. Here are a few tips:

• Specify laterality (left/right/bilateral) for strokes, tremors, or nerve disorders
  
• Clarify seizure type and frequency for epilepsy coding
  
• Indicate whether a condition is intractable or with status epilepticus
  
• Use time-based notes for prolonged services and cognitive assessments
  
• Clearly state the rationale for diagnostic tests such as MRI, EEG, or lumbar puncture

Neurology Coding and Telehealth

The COVID-19 pandemic accelerated the adoption of telemedicine in neurology, especially for follow-ups and chronic disease management. While many temporary changes have become permanent, physicians should be aware of:

• Place of service (POS) codes for telehealth
  
• Modifier 95 to indicate a synchronous telemedicine service
  
• Differences in private payer vs. Medicare policies

Neurologists must ensure that documentation supports the medical necessity and time spent during virtual visits.

Common Coding Errors in Neurology and How to Avoid Them

1. Undercoding E/M visits: Due to poor documentation of complexity or time.
   
2. Incorrect EEG code selection: Because of missing details about duration or video monitoring.
   
3. Misuse of diagnosis codes: Especially using unspecified codes when more specific ones are available.
   
4. Missing modifiers: Especially when billing both technical and professional components of tests.
   
5. Inadequate documentation: For prolonged services or remote monitoring time.
   

Regular training, coding audits, and the use of compliant EHR templates can help mitigate these risks.

The Role of Clinical Documentation Improvement (CDI)

Implementing a Clinical Documentation Improvement (CDI) program can significantly enhance coding accuracy. CDI teams work with neurologists to ensure that:

• Diagnoses are captured completely and accurately
  
• Intractability, laterality, and severity are documented
  
• CDI queries are responded to promptly
  

This leads to fewer denials, better quality scores, and improved revenue integrity.

Conclusion

As neurology coding continues to evolve, it’s imperative for physicians and coders to stay current with the latest CPT and ICD-10 changes. From EEG updates to new epilepsy classifications and expanded Parkinson’s disease coding, these changes impact both reimbursement and clinical reporting. Embracing proper documentation practices, telehealth coding guidelines, and CDI collaboration can significantly improve accuracy and reduce compliance risks.

Staying informed isn’t just about billing, it’s about delivering better care and sustaining your practice’s financial health in an increasingly complex healthcare environment.