# 95937



## orthopaedic01 (Aug 2, 2010)

Can someone please give me guidelines on how to properly bill for 95937 during a spinal surgical procedure?  How many units are allowable, etc.  Does anyone have a full description as well from CPT Assistant?


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## poonamsawant (Aug 3, 2010)

*Code 95937*

Indications and Limitations of Coverage and/or Medical Necessity [/U]
Indications 
Neuromuscular junction testing by repetitive stimulation may be reasonable and necessary to diagnose patients with known or suspected disorders of the neuromuscular junction. These include myasthenic syndromes such as myasthenia gravis and Lambert Eaton myasthenic syndrome (LEMS), as well as botulinum toxicity. Rarely, certain drugs such as aminoglycoside antibiotics can potentiate myasthenic symptoms. 

Limitations 

   1.  Neuromuscular junction testing by repetitive stimulation is not 
       considered reasonable necessary for indications other than those 
       listed above. 

   2.  Neuromuscular junction testing (CPT 95937) must not be billed for any 
       diagnostic test or procedure that does not meet the CPT definition of 
       CPT 95937. Examples include quantitative sensory testing by any means 
       and sensory nerve conduction threshold testing. Tests depending on the 
       patient's subjective response to stimulation (electrical, vibratory, 
       thermal or tactile), regardless of whether or not these data are 
       analyzed and presented through electronic or computerized systems, 
       also fail to satisfy the definition of CPT 95937. 

       NOTE: Quantitative Sensory Testing (QST) uses electrical or mechanical 
       stimuli at varying amplitudes to evoke patients' subjective responses. 
       Such tests are designed to be helpful in characterizing various types 
       and degrees of neural damage or impairment. However, the clinical 
       usefulness of such tests remains unclear. One such device is Current 
       Perception Threshold/Sensory Nerve Conduction Threshold test 
       (CPT/sNCT). CMS has determined that this test is not covered since 
       there is insufficient scientific or clinical evidence to consider this 
       device as reasonable and necessary within the meaning of 
       §1862(a)(1)(A) of the Social Security Act. (See Medicare Coverage 
       Issues Manual 50-57). Another such device is the pressure-specified 
       sensory device (PSSD), which relies on a pressure stimulus to 
       determine a sensory threshold. It is not appropriate to bill for QST, 
       including PSSD, under CPT 95937 or any of the following CPT codes: 
       95900, 95903, 95904, 95921, 95922, 95923, 95925, 95926, 95927. 

   3.  Neuromuscular junction testing by repetitive stimulation is not 
       considered reasonable and necessary for the diagnosis or treatment of 
       diabetic neuropathy. 

   4.  Neuromuscular junction testing by repetitive stimulation is not 
       considered reasonable and necessary for the diagnosis or treatment of 
       carpal or tarsal tunnel syndrome. 

   5.  Neuromuscular junction testing by repetitive stimulation is indicated 
       for specific physical signs and symptoms (e.g. diplopia, weakness, 
       dysphagia) only if there is actual clinical suspicion that a 
       neuromuscular junction disorder is the cause. 
Coding Guidelines 


   1.  Generally the interpretation or cognitive performance of the test is 
       considered part of the test and not an E&M service.  An E&M service 
       performed on the same date must be a separate and distinct service &   
       must be reported with the modifier 25. 

   2.  Use modifier TC when reporting the technical component of 95937.  The 
       technical component is payable in office (11), skilled nursing 
       facility (SNF) (31) only for patients whose Part A benefits have been 
       exhausted, and independent clinic (49). 

       Use modifier 26 when reporting the professional component of 95937. 
       The professional component is payable in office (11), inpatient 
       hospital (21), outpatient hospital (22), emergency room (23), skilled 
       nursing facility (SNF) (31) only for patients whose Part A benefits 
       have been exhausted, independent clinic (49), comprehensive inpatient 
       rehabilitation facility (61), comprehensive outpatient rehabilitation 
       facility (62) and ESRD treatment facility (65). 

   3.  Report code 95937 without a modifier if the global service is being 
       performed.  The global service may be billed in office (11), skilled 
       nursing facility (SNF) (31) only for patients whose Part A benefits 
       have been exhausted, or independent clinic (49). 

Hope this helps.
Dr. Poonam


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## orthopaedic01 (Aug 3, 2010)

Thank you Dr. Poonam,
A Nuvasive representative told me that when I bill this during spinal surgery I should bill by however many screws are tested.  Meaning if 8 screws were tested, I would bill 8 units of 95937.  Do you happen to know if there is a limitation on how many units to bill and if this is an accurate way to bill.  I would think you would bill by levels, not screws..?


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