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Anesthesia Coding Alert

READER QUESTION ~ Appeal Denials for Multiple NCS Claims

Published on Fri Jan 06, 2006

Question: Our pain management specialist often conducts multiple sensory and/or motor nerve conduction studies for patients. Some of our carriers only pay for four units per code, regardless of how many nerves the physician tests. How should we handle these cases?

Kansas Subscriber

Answer: Physicians often need to test multiple different nerves to reach a final diagnosis when patients complain of bilateral extremity pain, numbness or tingling. Some carriers predetermine limits for nerve conduction studies in their claims processing software, but you can usually submit documentation and reverse the denial.

Here's how: Code each nerve test individually, along with documentation that shows your physician's findings for each test.

Example: Right median sensory nerve, 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory); left median sensory nerve, 95904; right ulnar sensory nerve, 95904; left ulnar sensory nerve, 95904; right radial sensory nerve, 95904; left radial sensory nerve, 95904.

Extra help: Then include a copy of CPT's Appendix J, which states the nerves are considered to be separate and distinct from one another.

If your physician exceeds the number of studies outlined in the Appendix J table, ask him to dictate the medical necessity for exceeding the standards.

Example: Your physician might document, "I tested each digit in the left hand because the patient has a crush injury to that hand. It was necessary to assist in the determination of the extent of the injury and potential need for surgical treatment ..."

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