2018 December AANnews

VOLUME 32 · ISSUE 12 · DECEMBER 2018

FREE December 4 webinar explains E/M and QPP changes for 2019. See page 7.

2019 PRESIDENTIAL PLENARY SESSION Hear from Four Neurology Giants An impressive lineup has been confirmed for the 2019 Annual Meeting’s premier lectures during the Presidential Plenary Session from 9:15 a.m. to 12:00 p.m. on Sunday, May 5.

The hugely popular session will be moderated by Science Committee Chair Natalia S. Rost, MD, MPH, FAAN, FAHA, and open to all meeting attendees.

“The Presidential Plenary is the ultimate platform for recognizing some of the biggest names and greatest accomplishments in neurology,” said Rost. “These giants of neurology, who have been at the forefront of their fields for years, will be addressing seminal advances in neuro-oncology, movement disorders, and multiple sclerosis.”

Presidential Lecture

In non-AAN election years, this premier lecture is awarded to a neurologist chosen by the AAN president. In election years, the lecture is presented by the outgoing president.

“Neurology: Challenges, Opportunities, and the Way Forward” Ralph L. Sacco, MD, MS, FAHA, FAAN Miller School of Medicine, University of Miami, Miami, FL

Sacco

Monje

Lucchinetti

Mink

Continued on page 13

Sidney Carter Award in Child Neurology

Endowed by an anonymous donor and presented every year during the Presidential Plenary Session, this lecture recognizes outstanding work by an individual in the field of child neurology/developmental neurobiology.

Resolve to Renew Your Membership Before December 31

AAN Advocacy Scores Big Wins for Neurology

Don’t risk losing access to the world’s best neurology resources and education in the new year! By visiting AAN.com/dues and renewing today, you can be assured your AAN will be there for you come January 1 to help you grow and thrive professionally and personally.

President Ralph L. Sacco, MD, MS, FAHA, FAAN, shares the Academy’s success in fighting against proposed changes by CMS to E/M codes and victories in reducing administrative burdens. 

Be sure to renew before December 31 to retain access to essential education, science, and support, including: Exclusive member discounts on 2019 Annual Meeting Unique education opportunities to earn CME or MOC credits Continued on page 13

5

MIPS Benchmarking—What to Know and Do to Succeed

7

President’s Column

›

2019 Practice Management Webinar Changes Enable Greater Topic Depth

Continued on page 4

11 Annual Meeting

Programming: Dependable Meets Unexpected

›

›

In Multiple Sclerosis–

THE ART OF BRAIN PRESERVATION Adding Grey to the Palette Completes the Picture

GREY MATTERS, TOO

Learn more about Multiple Sclerosis at MSBrainPreservation.com/art © 2018 Celgene Corporation All rights reserved. 03/18 USII-CELG180067

AANnews · December 2018

NEWS BRIEFS

CONTENTS Neurology: Clinical Practice Delivers Value with Variety · · · · · · · · · · · · 10

Cover 2019 Presidential Plenary Session

Brain Surgery No Laughing Matter for Comedian Jim Gaffigan and Wife · · · · · · · · · · · · · · 10

Resolve to Renew Your Membership Before December 31 President’s Column AAN Advocacy Scores Big Wins for Neurology · · · · · 4 Tools & Resources MIPS Benchmarking— What to Know and Do to Succeed · · · · · · · · · · · 5 Register for Free December 4 Webinar: E/M and QPP Changes for 2019 · · · · · · · · · ·5 Medicare Fee Payment Schedule Final Rule: Effects on Neurology · · · · · · · · · · · ·6 2019 Practice Management Webinar Changes Enable Greater Topic Depth · · · · · · · ·7 Know These 2019 CPT Coding Changes Affecting Neurology · · · · · · · · · · · · · ·8

Education & Research December Continuum Explores Neurocritical Care · · · · · · · · · · · · · · · · 11 Conferences & Community Annual Meeting Programming: Dependable Meets Unexpected · · · · · · · · 12 Conjure up Your Best Ideas for Brainstorm Event at Innovation Hub · · · · · · · · 13 Section Elections to Take Place This Month · · · · · · · · 13 Policy & Guidelines Capitol Hill Report · · · · · · · · 14 Careers · · · · · · · · · · · · · · · · 14

The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.

Contact Information

For advertising rates, contact:

American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415

Eileen R. Henry Wolters Kluwer Health | Medical Research Lippincott, Williams & Wilkins

Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:

memberservices@aan.com

Website: AAN.com

Phone: (732) 778-2261 Email: Eileen.Henry@wolterskluwer.com

The AAN congratulates AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN, recently elected to the National Academy of Medicine (NAM). Membership in the NAM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievements and commitment to service. Sacco is professor and chairman of neurology and Olemberg Family Chair in Neurological Disorders, executive director of the Evelyn McKnight Brain Institute, director of Clinical and Translational Science Institute, and senior associate dean of Clinical and Translational Science at the University of Miami Miller School of Medicine. In 2010, he became the first neurologist to serve as president of the American Heart Association/American Stroke Association.

Comment on Neurology Outcome Measures Drafts AAN members are encouraged to comment on new draft measures tied directly to patient outcomes for neurology. These measures, related to numerous neurologic diseases, are intended to drive quality improvement for child, adolescent, and adult patients. Provide comments by December 21 at AAN.com/view/PublicComment. 

Search Begins for New Neurology Editor-in-Chief · · · · · · · · · · 10

The Vision of the AAN is to be indispensable to our members.

Sacco Honored by National Academy of Medicine

AAN Executive Director: Catherine M. Rydell, CAE Editor-in-Chief: John D. Hixson, MD Managing Editor: Angela Babb, CAE Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designers: Siu Lee Email: aannews@aan.com

AANnews is published monthly by the American Academy of Neurology for its 34,000 members worldwide. Access this magazine and other AAN publications online at AAN.com/go/elibrary.

The American Academy of Neurology ’ s registered trademarks and service marks are registered in the United States and various other countries around the world.

“American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.

President’s Column

AAN Advocacy Scores Big Wins for Neurology Following several months of strenuous AAN advocacy and objections to the significant flaws in its proposed rule, the Centers for Medicare & Medicaid Services (CMS) published its final 2019 Medicare Payment Fee Schedule in November—and the AAN came away with several big wins!

Sacco

Neurology was facing a major cut if the original CMS proposal to collapse payments for evaluation and management (E/M) codes was enacted.

Most importantly, CMS agreed to delay implementation of these changes in E/M codes until 2021. Neurologists have no major E/M payment change to deal with in 2019, as CMS had initially proposed collapsing the codes on January 1.

Instead, CMS modified its proposal and in 2021 will only collapse code levels 2-4 and maintain level 5—which recognizes the work of the very complex patients—rather than implementing its initial proposal to collapse levels 2–5. The E/M coding and payment structure will remain unchanged in 2019 and 2020. Neurologists should continue to use either the 1995 or 1997 documentation guidelines to document E/M office visits billed to Medicare.

In another big win for neurology, starting in 2021, neurologists also will be able to add-on a complexity code to their E/M visits that is reflective of the inherent complexity of certain non-procedural specialty care. This code specifically lists neurology as a complex non-procedural specialty. Neurologists will be able to use a new extended services code to account for longer visits. This recognizes the fact that our patients are more complex, often have multiple problems, and require extra efforts and time to adequately provide high-quality, patient-centered care.

More good news for AAN members includes an immediate rollout of documentation simplifications and CMS’s elimination of the multiple procedure reduction proposal. All of these things were asked for in our comment letter and numerous meetings with CMS since last July. Any reduction in regulatory burden is a significant move to improve wellness and reduce burnout for our members.

Our voices were heard! These are significant victories for Academy members, and we thank those of you who raised your voices to help speak out about the flaws in the proposed rule.

This was an all-out extraordinary effort by AAN leadership, members, and staff. We worked with numerous collaborative professional and patient advocacy organizations and harmonized our voices to stop these detrimental CMS rule changes.

We held several rounds of meetings with top officials at the Department of Health & Human Services and CMS—which also received our formal letter spelling out the reasons for our objections and the adverse impact the proposed rule would have on neurologists and patients. We

4

AANnews • December 2018

collaborated with multiple key associations to raise awareness on Capitol Hill, and 114 members of Congress signed a letter to CMS in support of our cause. Also, we received media coverage for our case in Policy and Medicine, Inside Health Policy, and a strong editorial written by Dr. Orly Avitzur, chair of our Medical Economics and Management Committee, and myself for the Washington Post published in October.

These CMS wins illustrate the importance of the AAN’s regulatory advocacy efforts on behalf of neurologists and their patients and demonstrate how we have been a national leader on this effort.

All of our advocacy strategy has paid off, as well as your continued support of our BrainPAC. We are delighted that CMS is allowing time for stakeholder input by delaying implementation until 2021. In the coming months, the AAN’s regulatory advocacy team will evaluate the impact of collapsing code levels 2-4 and lead efforts to address the changes directly with CMS leadership. Thank you for your steadfast support and being loyal members of the AAN. We will continue to diligently advocate for changes in regulatory policy on your behalf and for the improvement of care for our patients.

Read the AAN’s full summary of the final rule at AAN.com/view/SpeakOutNow. 

Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN rsacco@aan.com @DrSaccoNeuro on Twitter

Tools & Resources

MIPS Benchmarking—What to Know and Do to Succeed The requirements for the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) administered by the Centers for Medicare & Medicaid Services (CMS) are complex and can be confusing. AAN members may be unaware of how CMS has benchmarked quality measure performance and the impact these benchmarks can have on individual payment. Adam Webb, MD, and Sarah M. Benish, MD, FAAN, have answered some questions to help members better understand what benchmarking is, how it works, and how AAN members can use this information to succeed.

What is benchmarking?

Webb: Benchmarking is a method of evaluating performance between organizations and individual providers. For MIPS, CMS sets benchmarks each year for each quality measure in the program. The benchmarks are specific to each type of submission method. As a result, providers reporting on the same measure will have different benchmarks depending on if they are reporting the measure via claims, their EHR, or a registry such as the Axon Registry®.

How do these benchmarks impact MIPS scoring?

Benish: For the MIPS quality component, providers should be reporting on six measures and one of these measures should be an outcome measure. CMS will award between one to 10 points for each MIPS measure based on your performance compared to their benchmarks. So, if you meet the data completeness requirements and do better on the six measures you report compared to your peers, you could be awarded 60 points. On the other hand, if you don’t do as well as your peers or you pick measures without benchmarks, you could be awarded 6–18 points. The goal is to get as many points as possible so your payment adjustment is positive.

In English, that means a bonus rather than a penalty.

What is data completeness?

Webb: For quality measures reported via claims, providers must report on 60 percent of the individual MIPS-eligible clinician’s Medicare Part B patients for the performance period. For quality measures reported via a qualified clinical data registry (QCDR),

Webb

Benish

qualified registry, or EHR, eligible clinicians must report on 60 percent of the individual MIPS-eligible clinician’s patients across all payers for the performance period.

Benish: It is the minimum cases you need to report to CMS to get full credit for reporting the measure.

What should AAN members do to succeed?

Webb: Work with your team to identify measures early in the year and track performance regularly. You should be identifying measures that are meaningful to your patient populations.

Report on measures that have benchmarks and measures that don’t have benchmarks. Although CMS requires reporting on six measures, by reporting measures without benchmarks you can help CMS have enough performance data to establish benchmarks in future years.

Benish: Don’t get overwhelmed. For a lot of members in academic practices, their administration already is reporting this data for multiple specialties. Measure data on medication reconciliation, blood pressure monitoring, etc., is being collected.

Encourage your team to start reporting neurology measure data to help establish benchmarks. For solo and small practices, CMS has MIPS support available to you for free.

Where can members find information on benchmarking and the free MIPS support?

Benish: The AAN has this information available at AAN.com/ MACRA. CMS has information on their website at QPP.CMS.gov.

The AAN is available to answer questions at macra@aan.com. 

Register for Free December 4 Webinar: E/M and QPP Changes for 2019 The Centers for Medicare & Medicaid Services published its final rule on the Medicare Payment Fee Schedule for 2019 with a host of significant changes neurologists should be aware of. To help explain these changes and how they will impact AAN members, a free webinar—E/M, and additional coding changes as well as QPP/MIPS Changes for 2019—will be offered on December 4 at 12:00 p.m. ET. Faculty Sarah M. Benish, MD, FAAN, and Bruce H. Cohen, MD, FAAN, will help attendees: Understand payment changes in the Medicare Physician Fee Schedule effective January 1, 2019 Review final MACRA reporting requirements for 2018

DECEMBER

Learn how to implement new procedure codes (CPT) effective January 1, 2019 Identify opportunities and challenges for neurology practices based on final regulations

4

Register by December 3 at AAN.com/view/pmw18 to attend the live webinar, which will be posted for members to listen to at their convenience approximately five business days after the December 4 presentation. 

AANnews • December 2018 5

Tools President’s & Resources Column

Medicare Fee Payment Schedule Final Rule: Effects on Neurology On November 1, the Centers for Medicare & Medicaid Services (CMS) published its final rule on the 2019 Medicare Payment Fee Schedule. Most importantly to AAN members, CMS announced it would delay implementation of its proposal to collapse the evaluation and management (E/M) codes until 2021. It also made several other changes to its proposal, including removal of several administrative burdens on neurologists. Preliminary analysis of the final rule indicates that the AAN’s advocacy saved neurologists approximately $43 million annually in Medicare payment for E/M services starting in 2021. This is one of the AAN’s biggest advocacy wins ever.

The result is a major regulatory advocacy win for the AAN, which was cited by national media outlets as a leader in securing this outcome. The AAN objected strenuously to the negative aspects of the proposal and met five times with representatives from the Department of Health and Human Services after the proposed rule was released in July. We mobilized 133 patient and provider groups to join a letter sent to CMS opposing the proposal. Additionally, we lobbied Congress and members of both the House and Senate sent letters opposing the change.

E/M Updates As mentioned, CMS is delaying implementation of the proposal to collapse the evaluation and management (E/M) codes until 2021.

CMS also modified the proposal to collapse code levels 2-4 and maintain level 5, rather than implementing its initial proposal to collapse levels 2–5. CMS will be seeking more stakeholder input until the implementation date of 2021. CMS initially had proposed implementing the collapse of the codes on January 1, 2019.

Consequently, the E/M coding and payment structure will remain unchanged in 2019 and 2020. Neurologists should continue to use either the 1995 or 1997 documentation guidelines to document E/M office visits billed to Medicare.

Starting in 2021, neurologists will also be able to add-on a complexity code to their E/M visits that is reflective of the inherent complexity of certain non-procedural specialty care. This code specifically lists neurology as a complex non-procedural specialty.

Neurologists will be able to use a new extended services code to account for longer visits.

The AAN applauds CMS’s decision to immediately implement several proposals to provide physicians with documentation burden relief. Starting in 2019, for established patient office visits, neurologists may choose to focus their documentation on what has changed since the last visit and do not need to re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed. Additionally, neurologists will not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary.

CMS also is removing the requirements for notations in medical records that may have previously been included by residents or other members of the medical team for E/M visits furnished by teaching physicians.

The AAN also appreciates CMS’s decision not to implement its proposal to apply a multiple procedure payment reduction to E/M visits furnished on the same day as a procedure. Payment rates for the cheaper of the two will be maintained, rather than halved, as was initially proposed.

The final rule underscores the importance of the AAN’s regulatory advocacy work. According to CMS, the agency intends to “engage in further discussions with the public over the next several years to potentially further refine our policies, through future notice and

comment rulemaking, for 2021.” The AAN will continue analyzing this rule and expects to meet with stakeholders, including officials at CMS, in the future.

Read a more detailed summary of the E/M changes at AAN.com/view/2019rule.

Coding Changes for 2019 As part of an ongoing review of potentially misvalued services, a handful of neurology codes were reviewed by the AMA Relative Value Scale Update Committee (RUC) for 2019. Specifically, codes to report the analysis/programming of implanted cranial and brain neurostimulators. Despite objections from the AAN and the AMA, CMS has finalized work values for the services that are a reduction from AAN and RUC recommendations.

More information about new payment rates is available at AAN.com/view/FeeForService.

Acute Stroke Telehealth Reimbursement Thanks to AAN advocacy efforts, Congress recently removed the restrictions on the geographic locations and the types of originating sites where acute stroke telehealth services can be furnished.

CMS is implementing the law by creating a new modifier that will be used to identify acute stroke telehealth services.

The practitioner and, as appropriate, the originating site, will add this modifier as clinically appropriate to the HCPCS code when billing for an acute stroke telehealth service or an originating site facility fee. By billing with this modifier, practitioners indicate that the codes billed were used to furnish telehealth services for diagnosis, evaluation, or treatment of symptoms of an acute stroke.

Telemedicine For the first time, CMS will provide access to “virtual” care. The rule allows Medicare to pay providers for new communication technology-based services, such as brief check-ins between patients and practitioners, and pay separately for evaluation of remote pre-recorded images and/or video. CMS is also expanding the list of Medicare-covered telehealth services.

Qualified Clinical Data Registries (QCDRs) Based on the concerns raised by stakeholders, CMS decided not to finalize a proposal which would have required QCDRs to

enter into a measure licensing agreement with CMS. This decision protects the intellectual property of organizations operating QCDRs, like the AAN with its Axon Registry®, and ensures that QCDR measure developers maintain control over the right to license their measures to other QCDRs. They will continue with the policy previously in place that QCDRs wishing to use another’s measures must request and obtain permission. The AAN pushed very hard for this outcome. We met with members of Congress and joined a coalition that sent a letter to CMS opposing this proposal.

Quality Payment Program Updates This is the first year CMS included updates to the Quality Payment Program (QPP) in the final Physician Fee Schedule rule. For 2019, CMS continues to ramp up the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) requirements.

The minimum performance threshold for MIPS was increased to 30 points, up from 15 points in 2018, and the exceptional performance threshold was increased to 75 points, up from 70 points.

The agency finalized a new criterion for the low-volume threshold exclusion that is based on the total number of covered professional services under the payment fee schedule. Additionally, CMS finalized an opt-in opportunity that will allow physicians who meet or exceed at least one of the low-volume threshold criteria to choose to participate in MIPS. The MIPS category weights are changed slightly—Quality is decreased to 45 percent of the overall MIPS score, Cost is increased to 15 percent, Promoting Interoperability (formerly Advancing Care Information) remains at 25 percent, and Improvement Activities remains at 15 percent.

Additionally, CMS is modifying the small and solo practitioner bonus. Instead of bonus points being added towards the overall MIPS score, small and solo practitioners who submit at least one measure would receive 6 points towards their quality score.

Keep informed about QPP with AAN resources at AAN.com/view/ MACRA or visit the CMS website at QPP.cms.gov. 

2019 Practice Management Webinar Changes Enable Greater Topic Depth The AAN’s popular Practice Management Webinar series is undergoing significant changes for 2019. The number of webinars will be reduced from past years, but each new webinar is designed to allow for a deeper dive into the subject matter and invite more questions from participants.

A live, 30- to 45-minute webinar with faculty will introduce each topic and enable registrants to ask questions. In the weeks following the webinar, several shorter recorded webinars will be posted on AAN.com that explore the topic in greater depth, and participants can access these at their convenience. Finally, each topic will conclude with a 30-minute webchat, so participants can ask further questions.

Watch for further AANnews stories in the months ahead that provide greater detail on each upcoming webinar.

January 15

Boss, MD: Managing a Better Practice J. Todd Barnes, MBA, CMPE; Seth Lefberg

March 12

Understanding How You Get Paid Bruce H. Cohen, MD, FAAN; Raissa Villanueva, MD, MPH, FAAN; Jeffrey Waugh, MD, PhD; Korwyn Williams, MD, PhD

May 21

October 1

Everything You Wanted to Know About Your Patients but Were Afraid to Ask: Having Difficult Conversations with Patients from Vulnerable Populations

Using Technology for Better Practice Management of Stroke Mark J. Alberts, MD, FAHA; Elaine C. Jones, MD, FAAN; Lawrence R. Wechsler, MD, FAAN

Farrah N. Daly, MD, MPH; Christopher T. Doughty, MD; Justin P. Martello, MD; Allan D. Wu, MD, PhD

November 19

Seeing the Future Clearly: How to Succeed in 2020

August 13

Increasing Revenue in Your Practice: Care Models, Ancillary Services, and Other Strategies

Joel M. Kaufman, MD, FAAN

David A. Evans, MBA You can purchase a single webinar for $99 or subscribe to the complete series of 2019 webinars for only $189—that’s less than $32 per webinar! Webinars are accessible through the AAN Online Learning Center and feature: Convenient live webinar sessions starting at 12:00 p.m. ET On-demand access to webinar recording and presentation slides if you miss the live event 2 AMA PRA Category 1 Credits™ per webinar for physicians, or certificate of completion for non-physicians Visit AAN.com/view/pmw19 to learn more and register or contact Jessica Nickrand at jnickrand@aan.com. 

AANnews • December 2018 7

Tools & Resources

Know These 2019 CPT Coding Changes Affecting Neurology The following is a summary of major CPT coding changes affecting neurology in 2019. To learn more about these changes and how they will impact AAN members, attend the free webinar on December 4, E/M and QPP Changes for 2019. Register for the webinar or view the recording at AAN.com/view/Webinar2019.

Electrocorticography Effective January 2019, neurologists will be able to report new code 95836 for the ongoing recording and interpretation of electrocorticography (ECoG) from electrodes chronically implanted on or within the brain. Surgically implanted electrodes allow for intracranial recordings to continue after the patient has been discharged from the hospital. Code 95836 includes unattended ECoG recording with storage for later review and interpretation during a single 30-day period and may be reported only once for each 30-day period. The specific dates encompassed by the 30-day period must be documented in the written report.

•95836 Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days

Neurostimulators, Analysis-Programming 2019 brings significant changes to neurostimulator analysis and programming CPT codes. Changes to existing CPT codes 95970, 95971, and 95972 are editorial. Existing CPT codes 95974, 95975, 95978, and 95979 will be deleted and replaced with four news codes. These changes include: Clarify reporting of cranial nerve, spinal, peripheral nerve, sacral nerve, and brain neurostimulator services Revise CPT guidelines to define neurostimulator programming and analysis services, acknowledging the work associated with programming may or may not result in any change of the final programming parameters Add language to specify anatomy within the codes Add definitions and anatomical explanations to the guidelines that provide insight regarding the nervous system components being treated, and the granularity in reporting mechanisms for each nervous system component

Revised codes: ▲95970 Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming

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AANnews • December 2018

▲95971 with simple spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/ transmitter programming by physician or other qualified health care professional ▲95972 with complex spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/ transmitter programming by physician or other qualified health care professional (95974, 95975 have been deleted. To report, see 95976, 95977) (95978, 95979 have been deleted. To report, see 95983, 95984) New codes: Cranial nerve neurostimulator programming codes are no longer based on time; rather, they are differentiated by simple or complex: Simple programming of a neurostimulator pulse generator/transmitter includes adjustment of one to three parameter(s).

Complex programming includes adjustment of more than three parameters.

•95976 with simple cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional •95977 with complex cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional Brain neurostimulator programming codes are reported according to the face-to-face time, differentiated by the initial 15 minutes and each additional 15-minute increment of time.

•95983 with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional •+95984 with brain neurostimulator pulse generator/ transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure) + = Add on code • = New code ▲ = Revised code

“2019 will bring some notable changes in how neurologists bill for the work of analyzing and programming neurostimulators, including vagus nerve stimulation for the treatment of epilepsy and deep brain stimulation for the treatment of Parkinson disease and other movement disorders” said Bruce H. Cohen, MD, FAAN, chair of the AAN’s Coding Subcommittee and AAN Advisor to the AMA CPT Editorial Panel. “The restructuring of these codes is the result of the ongoing review of CPT codes

by the Centers for Medicare & Medicaid Services (CMS). CMS continuously and independently identifies codes as ‘potentially misvalued’ based on a number of criteria. The identification of these codes by CMS is what triggers all specialty societies, including the AAN, to respond to CMS with recommendations.

These recommendations occur through the AMA’s CPT and code review process, which requires a plan of action, with the ultimate valuation recommendation coming from Medicare.

In general, the new codes reflect changes in technology and physician work flow, but ultimately tend not to be favorable in

terms of reimbursement. The new structure for these codes recognizes some efficiencies in the services and attempts to align similar technologies with the same model for identifying the service delivery. For example, the VNS programing codes have changed from time-based reporting to reporting based on complexity of work. Although these changes may result in decreased reimbursement for some procedures, these changes in the VNS code structure will make it easier to submit codes for brief encounters for VNS programming.” 

Relative Value Unit (RVU) Changes to Cranial Nerve Neurostimulator Pulse Generator / Transmitter Programming 2018 CPT Code

2019 New CPT Code

2018 Physician Work RVU

2019 Physician Work RVU

95974

•95976

3.00

0.73

Simple programming of cranial neurostimulator (one to three parameters); time requirement removed from CPT guidelines

+95975

•95977

1.70

0.97

Complex programming of cranial neurostimulator (four or more parameters); time requirement removed from CPT guidelines

Changes to Code Structure

RVU Changes to Brain Neurostimulator Pulse Generator / Transmitter Programming 2018 CPT Code

2019 New CPT Code

2018 Physician Work RVU

2019 Physician Work RVU

95978

•95983

3.50

0.91

Time requirement for initial code reduced from 60 to 15 minutes

+95979

•+95984

1.64

0.80

Time increment for additional code reduced from 30 to 15 minutes

Changes to Note

The following table has been added to the 2019 CPT Book to assist with correct reporting of brain neurostimulator analysis and programming services: Physician or Other Qualified Health Care Professional Face-to-Face Time for Brain Neurostimulator Analysis with Programming

Code(s)

Less than 8 minutes

Not reported

8–22 minutes

95983 x 1

23–37 minutes

95983 x 1 + 95984 x 1

38–52 minutes

95983 x 1 + 95984 x 2

53–67 minutes

95983 x 1 + 95984 x 3

68 minutes or longer

Add units of 95984

CPT codes, descriptions, and other data are copyright 2019 by the American Medical Association, and all rights are reserved and applicable FARS/DFARS clauses apply.

AANnews • December 2018 9

Tools & Resources

Search Begins for New Neurology Editor-in-Chief The AAN is seeking a new editor-in-chief for its flagship journal Neurology ® to follow current Editor-in-Chief Robert A. Gross, MD, PhD, FAAN, who will complete his term in April 2020.

Interested neurologists may apply for this position by submitting a curriculum vitae and a proposal describing your vision and proposed plans for the journal. Visit Neurology.org/EditorSearch for more details on the proposal requirements.

The editor-in-chief has the final responsibility for editorial decisions regarding all content in the journal, developing and implementing the strategic vision for the journal in conjunction with the Neurology editorial leadership team and staff, promoting the journal to the neurology community, overseeing the peer review process, and overseeing the subspecialty journals and other journal programs.

Under Gross’ leadership, the AAN’s flagship journal has evolved from a single title to a strongly branded main journal with three subspecialty journals in the areas of clinical practice, neuroimmunology and neuroinflammation, and neurogenetics.

In addition, the journal contains an enthusiastic online-only Resident & Fellow Section, a podcast program, and two ancillary online sites featuring articles and blogs on international neurology and health services research.

It is expected that the new editor-in-chief will Gross be announced in August or September 2019.

The successful candidate will serve as a part-time editor beginning in October 2019 for a six-month overlap period with the current editor. During this period, the new editor will appoint the deputy editor, associate editors, and Editorial Board for the editor’s term. The editor will receive a stipend.

The due date for proposals is April 1, 2019. Proposals should be addressed to the Neurology Editor-in-Chief Search Committee and emailed to Patty Baskin, Executive Editor of the Neurology journals, at pbaskin@neurology.org with the subject heading “Editor-in-Chief Position Proposal.” 

Neurology: Clinical Practice Delivers Value with Variety

Volume 8, Number 5, October 2018

Neurology.org/CP

The October 2018 issue of Neurology ® Clinical Practice offers a cornucopia of articles of benefit to neurologists in clinical practice. Shin Chien Beh, MD, presents research on “Clinical Characteristics of Alice in Wonderland Syndrome in a Cohort with Vestibular Migraine.” Joseph I. Sirven, MD, FAAN, reviews “Is There a Neurologist on this Flight?” Mary A. Iaccarino, MD, explores a link between “Sport Concussion and Attention Deficit Hyperactivity Disorder in Student Athletes: A Cohort Study.” The journal also includes a commentary by Anup D. Patel, MD, FAAN, on “Utilizing the Axon Registry® for Quality Improvement.”

Neurology: Clinical Practice, published six times a year, is available in print (for US members only), online, and for the iPad and Android. Visit Neurology.org/cp for more information. 

A peer-reviewed clinical neurology journal for the practicing neurologist

RESEARCH

Clinical characteristics of Alice in Wonderland syndrome REVIEW

“Is there a neurologist on this flight?”

RESEARCH

Sport concussion and ADHD in student athletes COMMENTARY

Utilizing the Axon Registry® for quality improvement

Brain Surgery No Laughing Matter for Comedian Jim Gaffigan and Wife 0 1 8/JA N UA RY DECEMBER 2

2019

Cannabidiol Medical Marijuana for Epilepsy and Other Disorders Nutrition What Kind of Fish Is Good for the Brain?

Physical Therapy How High-Tech Tools Are Advancing Recovery

Humor is something we’ve always found useful for coping.”

AN D JIM GAFFIG O JEANNIE AN — C O M E DY D U MOR I E ’S B R A I N T U ABOUT JEANN

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AANnews • December 2018

Comedian and television star Jim Gaffigan and his writer/producer wife, Jeannie, are featured on the cover of the December 2018/January 2019 issue of Brain & Life®. In April 2017, Jeannie had a nine-hour surgery to remove a benign papilloma wrapped around her brainstem. The Gaffigans share how her recovery has been both longer and more difficult than they expected.

The promise of cannabidiol therapies is explored following the recent FDA approval of Epidiolex to treat children with Lennox-Gastaut syndrome. This article looks at how cannabidiol works and whether it can be used to treat other neurologic conditions and explains the difference between marijuana extracts used in clinical trials and what’s available at dispensaries in states where marijuana has been legalized.

Brain & Life magazine is a free resource for AAN members in the United States to distribute to patients, who also can subscribe for free. If you need to adjust the number of copies you receive for your patients or update your clinic address, email BeGreen@WasteFreeMail.com. All members have online access to the magazine articles and additional resources at BrainandLife.org. 

Education & Research

December Continuum Explores Neurocritical Care The December issue of Continuum: Lifelong Learning in Neurology ® explores issues around Neurocritical Care.

management of patients with subarachnoid hemorrhage, stroke, status epilepticus, and coma to information dealing with end-of-life care and shared medical decision making.”

“One of the striking points that is presented in this issue is the fact that the care of Suarez All the articles have comatose survivors of cardiac corresponding interviews on arrest should be a primary Continuum Audio®, which now is included concern for neurologists as the main aim is to provide neuroprotection,” in a subscription to Continuum®. said Guest Editor Jose I. Suarez, MD, AAN members pay only $349 per year FNCS, FANA. “Neurologists will find for a subscription to Continuum and interesting and authoritative reviews Continuum Audio. Subscribe now by of the diagnosis and management of using the convenient check-off box on disorders commonly encountered in your AAN membership dues statement; the neurocritical care setting. A group by contacting Wolters Kluwer at (800) of expert academic neurointensivists 361-0633, (301) 223-2300 (international); covers topics essential to all or Shop.LWW.com/continuum. Junior neurologists, from the assessment and members who are transitioning to

neurologist memberships can receive a 50-percent discount on the already low member rate for the Continuum and Continuum Audio subscription. 

Continuum LIFE LON G LEAR NING IN NEU ROLO GY®

Neurocritical Ca re

DECEMB ER 2018

VOL. 24

NO. 6

EDITOR- IN-CHIEF : STEVEN L. LEWIS, MD, FA AN GUEST EDITOR: JOSE I. SUAREZ, MD, FNCS, FANA

CONTINU UMJOUR

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Conferences & Community

Annual Meeting Programming: Dependable Meets Unexpected AAN Annual Meeting attendees have come to count on more than more than 250 expert-led, cutting-edge education opportunities, the most current breakthrough scientific research, and seemingly endless networking opportunities among a worldwide community of more than 14,000 neurologists and neurology professionals.

But an AAN Annual Meeting is even more than that, and 2019 will be serving up a number of new and unexpected experiences in exciting and inspirational formats to fuel your mind, body, and spirit.

What’s more is that we’re continuing to curate Annual Meeting programming into topics of interest for specific audiences to create even more stimulating learning opportunities that can be applied directly to professional and personal knowledge and growth. So, no matter what your career stage or subspecialty area of interest, you’ll find innovative, creative, and useful experiences at every point throughout the week.

Look for specialty tracks that include Academic Medicine, Business of Neurology, Career Essentials, Foundations of Clinical Neurology, Neurohospitalist, and Spanish Language; Experiential Learning Areas for creative, innovative, and interactive learning; and “Continuing the Conversation” and “What Do I Do Now?” opportunities after select courses. And because of the meeting’s single registration rate and fully flexible format, you can tailor your schedule to fit in all your favorites.

Here are just some of the daily highlights and new happenings throughout the week. Visit AAN.com/view/AM19 to view the full program.

SATURDAY

Programming for Future Researchers

Join other trainees in programming created specifically to help you strengthen your future career in research. Kick off the week with the Futures in Neurological Research Boot Camp from 12:00 p.m. to 5:00 p.m. (luncheon and reception included), receive more guidance at Monday’s Futures in Neurological Research Luncheon, then round out your experience with researchrelated programming and training throughout the week.

AAN Business Meeting

Join Academy leadership as they consider the Nomination Committee’s slate of nominees for election to the 2019–2021 AAN Board of Directors, and review member accomplishments and 2018 fiscal performance.

Advancing Medicine: Inspiration and Innovation

Three talks throughout the Annual Meeting will explore where neuroscience intersects with global themes. Explore subjects like medicine and the Flint, MI, water crisis; how neurology interfaces with AI and robotics; and what happens when neuroscience and philosophy collide.

SUNDAY Exhibit Hall Opening Lunch

Enjoy a complimentary lunch while mingling with fellow attendees and previewing the latest products and services available in the neurologic industry.

Immersive Learning

Immerse yourself in the brain’s inner workings with a guided audio-visual tour through a larger-than-life brain.

Medical Student Programs

Experience unique opportunities throughout the day that offer exposure to a variety of interests and career disciplines, and networking with leading neurologists and neurology professionals from around the world.

The Philly Spectacular—at Reading Terminal Market!

Kick off the Annual Meeting with a celebration at one of the United States’ largest and oldest public markets including delicious food and beverages and meeting and mingling with old—and new—friends.

MONDAY–THURSDAY Look for top education programming offering the latest updates and information you need to succeed, scientific poster sessions featuring the latest research and opportunities to speak directly with authors, premier plenary sessions featuring the biggest names in neurology, and the Academy’s biggest public education opportunity—Brain Health Fair, taking place on Thursday. Other highlights include:

Monday

Contemporary Clinical Issues Plenary Session, Exhibit Hall Networking Reception, Faculty and Trainee Reception, Neuroscience in the Clinic on Interpretation of Genetic Results

Tuesday

Clinical Trials Plenary Session, 5k Run/1K Walk for Brain Research, Scientific Update in Spanish, Neuroscience in the Clinic on Immunotherapies in Neurological Disease

Wednesday

Frontiers in Neuroscience Plenary Session, American Brain Foundation Commitment to Cures event, two Neuroscience in the Clinic Sessions on Stems Cells and Wearable Technology

Thursday

Controversies in Neurology Plenary Session, evening Case Studies Program, Neuroscience in the Clinic on the Brain Across the Menstrual Cycle

FRIDAY

Science Innovative Lunch

Featuring the ‘best of” scientific posters, abstracts, and invited science from the week

Four Neurology Update Programs

Covering movement disorders, aging/dementia, epilepsy, and neuro-ophthalmology/neuro-otology

Four Scientific Sessions

Selected to appeal to a wide variety of attendees, sessions will cover MS, neuromuscular, stroke, and headache

Education Blitz Programs

Quick fire education programming for those hungry for more learning opportunities

Closing Party

Celebrate the end of a great meeting at a special May Day-themed event

Secure your preferred hotel and the best savings on registration by visiting AAN.com/view/AM19 before the March 7 early registration deadline. 

Conferences & Community

Conjure up Your Best Ideas for Brainstorm Event at Innovation Hub The highly popular Brainstorm: A Competition for the Innovator in All of Us will return to the Innovation Hub presentation stage in the 2019 Annual Meeting Exhibit Hall—and we’re seeking your ground-breaking idea submissions! The game-style event allows participants to present on stage before a panel of AAN member judges their inventive solutions to challenges related to patients, practice, or any other medical-related issue, with discussion and critique following.

AAN members who are interested in presenting highly original ideas at the event are encouraged to submit a video, no more than 90 seconds long, giving a brief description of the challenge and solution. Learn more and submit your video at AAN.com/view/AM19.

All Annual Meeting attendees are invited to attend the event on Monday, May 6, from 4:00 p.m. to 5:30 p.m. to watch their trailblazing colleagues. 

Section Elections to Take Place This Month Members of the following AAN Sections will have an opportunity to cast their votes for new section chair and vice chair positions when voting opens later this month. Keep an eye out for email announcements with links to the online voting. If you have any questions, contact sections@aan.com.

Autoimmune Neurology Section Autonomic Nervous System Section Behavioral Neurology Section Business Administration Section Child Neurology Section Critical Care & Emergency Neurology Section

Endovascular & Interventional Neurology Section Ethics Section Headache & Facial Pain Section History Section Neurogenetics Section Neurohospitalist Section

2019 Presidential Plenary Session continued from cover “Myelin Plasticity in Health and Disease” Michelle Monje, MD, PhD / Stanford University, Stanford, CA

H. Houston Merritt Lecture

This lecture honors excellence in education involving clinically relevant research and is awarded every other year during the Presidential Plenary Session.

“Neuronal Ceroid Lipofuscinosis: Natural History Studies in Rare Neurodegenerative Disease” Jonathan W. Mink, MD, PhD, FAAN / University of Rochester, Rochester, NY

Robert Wartenberg Lecture This annual lecture is awarded to a neurologist for excellence in clinically relevant research.

“Progress in Understanding Progressive MS: From the Microscope to the Bedside” Claudia F. Lucchinetti, MD, FAAN / Mayo Clinic, Rochester, MN 

Neuroimaging Section Neuroinfectious Disease Section Neuromuscular Section Pain & Palliative Care Section Stroke & Vascular Neurology Section 

Resolve to Renew Your Membership Before December 31 continued from cover Up-to-date information on breakthrough scientific research Valuable clinical practice guidelines The latest news relevant to the profession Representation of your interests at the federal/state levels Special pricing on AAN products, services, or meetings Exclusive access to AAN.com member-only resources Find the full list of exclusive member benefits at AAN.com/view/benefits. Please note that all AAN Junior memberships are now on the academic year cycle, running July 1 to June 30.

For more information, contact AAN Member Services at memberservices@aan.com, (800) 879-1960, or (612) 928-6000 (international). 

AANnews • December 2018 13

Policy & Guidelines

Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport.

Below are some recent highlights.

Listen to Free Webinar Analysis of Midterm Election Results on Neurology Want to know the outlook for neurology issues in the new Congress? Listen to a free recorded webinar conducted by AAN advocacy leaders analyzing the federal midterm election results and their likely effect on issues important to neurology.

BrainPAC Executive Committee Chair Glen R. Finney, MD; Government Relations Committee Chair Nicholas E. Johnson, MD, FAAN; and AAN Vice President Ann H. Tilton, MD, FAAN, hosted the free post-election webinar and discussed outcomes from the most prominent races and the potential impact on AAN legislative priorities. Hear the recording at AAN.com/ policy-and-guidelines/advocacy/BrainPAC.

AAN.com/careers Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added.

Medical Officer The Center for Devices and Radiological Health's Office of Device Evaluation is searching for outstanding neurologists interested in the regulatory review process of new medical devices and their safety and effectiveness evaluation prior to their introduction to the marketplace. As members of a multidisciplinary team of scientists and clinicians in the Division of Neurological and Physical Medicine Devices, medical officers consult in the review of devices in one or more of these product areas: rehabilitation devices including orthoses, prostheses, pain management devices, brain-computer interfaces, diathermy devices, and functional electrical stimulators; neurostimulation devices including spinal cord stimulators, peripheral nerve stimulators, and deep brain stimulators; EEG and non-EEG based neuro-diagnostic devices, mobile medical apps; neurosurgical, neurovascular and neuro-interventional devices. Qualifications: Doctor of Medicine or Doctor of Osteopathy from a school in the United States or Canada approved by a recognized accredited body in the year of the applicant's graduation or a Doctor of Medicine or equivalent degree from a foreign medical school that provided education and medical knowledge substantially equivalent to accredited schools in the United States. Clinical fellowship/practice in Neurology is required. Clinical fellowships or expertise in neurological disorders, including stroke, dementia and neuromuscular diseases is desirable. Location: Office is located in Silver Spring, Maryland on the White Oak Campus.

Salary: For medical officers, Civil Service salary range starting at $137,508.00 per year. Salary and level of responsibility are commensurate with education and experience. Benefits: Outstanding leave package, Health Insurance, Life Insurance, Retirement, Maxiflex Schedule, Telecommuting, Health Units, Fitness Centers and participation in Federal Credit Unions. There are opportunities for professional development, which may

14

AANnews • December 2018

include further training, attendance at scientific meetings and conferences, and clinical activities. How to apply: Interested candidates should send a CV and cover letter to CDR Avena Russell: avena.russell@fda.hhs.gov; FDA/Center for De vices and Radiological Health, Office of Device Evaluation, Division of Neurological and Physical Medicine Devices.

Pediatric Neurology—Join One of the Best Healthcare Providers/Teaching Hospital in West Virginia Competitive salary with full benefit package. $50K sign-on bonus. More than 30 specialties are represented. Procedures performed: Advanced MS infusion therapies, Electromyography (EMG), Electroencephalogram (EEG), Evoked potentials studies, Lumbar puncture, Nerve conduction studies, Therapeutic injections for migraine and Epilepsy Monitoring Unit for long-term monitoring. *Neurology department specializes in the following conditions Autism, Cerebral palsy, Dementia, Epilepsy, Multiple sclerosis (MS), Neuropathy, Stroke, Seizures, Migraine, Nerve and muscle disorders and Tremors. "Hip, Historic and Almost Heaven"— Tourism Board. The cultural, recreational, and business capital of the Appalachian Mountains. Excellent Public and Private Schools. NCAA Division I Intercollegiate Sports Teams. Driving distance for skiing, water sports, hiking, etc. Bike friendly community with a network of trails. Art walks, downtown street festivals and brown bag concert series. Come play—multiple family friendly venues and activities. Timothy Stanley, Direct: (404) 591-4224, or (800) 492-7771, tstanleyweb@phg.com; Fax: (404) 591-4237; Cell/Text: (770) 265-2001. Mention code 180802—CHN. Interventional NeuroRadiologist Needed, in Charlottesville, Virginia Sentara Martha Jefferson Hospital has a full time

employment opportunity for a board certified/board eligible Interventional NeuroRadiologist to lead our regional neurovascular program. We provide 24/7/365 coverage for ischemic and hemorrhagic stroke and elective endovascular procedures. We are currently a primary stroke center with plans for comprehensive stroke center status. At Martha Jefferson, we are committed to our patients’ well-being, to providing caring, personalized service to all people and to exceeding the expectations of those we serve by creating an extraordinary healthcare experience. We strive to create a healthcare environment where safety and quality are the cornerstones to delivering exceptional healthcare. Our physicians are actively involved with the Hospital in continuously improving clinical quality and the quality of the patient's experience.

Competitive salary and benefits. This is not a J-1 or H1-B Visa opportunity. Contact Judy Tobin at jdtobin@sentara.com

AANnews® Classified Advertising he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities.

Visit careers.AAN.com for all AAN options, rates, and deadlines. d copy for the February 2019 print edition of A AANnews must be submitted by January 1, 2019. The same deadline applies to changes/cancellations. he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.

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