# pain managment nerve conduction study



## annieledesma (Jun 16, 2015)

Can somebody help me please!!  I am so confused with the Nerve conduction studies that my doctor started doing. I don't understand how to get the number of nerves he tested. I attached the report below so if someone can help me determine how many nerves I need to bill for and what cpt code I should use? Any help I would greatly appreciate it.


Presumptive Diagnosis: Sensory cervical plexus disorder without symptoms/signs of motor deficit. 

Sensory NCS amplitude, velocity/latency and configuration of summation/recruitment Evidence based medicine and safety is maximized with Type III (A-delta) sensory NCS. Injury causes glutamine neurotransmitter depletion, which results in A-delta fibers requiring higher than average voltage to initiate threshold summation, which is detected by real-time mV measurements.1 2Peer-reviewed statistical sensitivity approaches 100%3 with published reports supporting improved treatment localization in 56% of cases.4 Needle EMG is contraindicated in the absence of obvious muscle atrophy5. SSEP is a useful method of verification.

Findings: 
Higher than average measures ? Deviation Index Mild (+1) to Very Severe (+5): 
RIGHT (C2) GREATER OCCIPITAL NERVE +4 SEVERE
LEFT (C2) GREATER OCCIPITAL NERVE +3 MARKED
LEFT (C8) ULNAR NERVE +2 MODERATE

Lower than average measures: 
LEFT (C5) AXILLARY NERVE -1 HYPER
RIGHT (C7) RADIAL NERVE MEDIAL BRANCH -1 HYPER


Diagnostic Summary:
The most significant findings are in bold font above. 

Interpretive Considerations:
Lower than average measures suggest irritation which warrants investigation to detect possible concomitant pathology. Chronicity is suggested when central disinhibition causes a hyper measure (low on graph) to be directly opposite of a rated down-regulated measure (high on graph). Normal findings do not rule out non-neurogenic pain generating etiologies, such as muscle or ligament strain. Since pathology can influence adjacent nerve tracts, it is essential to correlate all findings before initiating or altering treatment.


UNADJUSTED EXAM DATA: (Amplitudes are represented by whole numbers for ease of comparison)
C2R / C2L -- 44 / 42; C3R / C3L -- 22 / 20; C4R / C4L -- 20 / 22; C5R / C5L -- 22 / 16; C6R / C6L -- 24 / 28; C7R / C7L -- 24 / 32; C8R / C8L -- 38 / 46; T1R / T1L -- 20 / 20; T2R / T2L -- 22 / 26


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## kwatson0 (Apr 10, 2018)

*Ncs*

Hi there did you find out to bill. If so I need your guidance.  I just received my first one


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## talton0206 (Apr 12, 2018)

I coded NCV's for a short time a couple of years ago.  The technicians counted submitted the # of studies with the reports.  The guidelines are very detailed about what must be tested and documented, H waves, F waves, was it a sensory nerve, motor nerve...........  

That said, I can't help with the coding but would recommend posting your question in the neurology / neurosurgery forum.

Good Luck,

Tammy


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