Anesthesia Coding Alert

Question: Is it possible for a pain management physician to bill for nerve conduction studies with E/M services? Florida Subscriber Answer: In general, E/M services are not payable in conjunction with nerve conduction studies. The exception is if the physician provides a medically necessary and separately identifiable E/M service at the time of the study. For example, a patient is scheduled to undergo nerve conduction studies but presents with a headache possibly unrelated to the suspected diagnosis. In this instance, the physician may examine the patient to determine the cause of the headache.

Another exception involves a change in the treatment plan when the physician performs a service, such as a therapeutic injection, that is the result of an examination and is separately identifiable from the nerve conduction studies. Under both circumstances, modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) would be appended to the E/M code. Most carriers require that nerve conduction studies be performed with standard electrodiagnostic equipment. Portable, hand-held devices used for screening and for psychophysical measurement (current, vibration and thermal perceptions) are not eligible for separate payment. Carriers also require that most electrodiagnostic tests be performed by or under the supervision of a physician or a board-certified physical therapist.