EM Coding Alert
Separating E/M From NCS Requires HEM
Question: Is it appropriate to bill an E/M in addition to a nerve conduction study (NCS, 95905) on the same date of service when the only assessment is in relation to the symptoms or diagnosis related to the NCS?
Maine Subscriber
Answer: You should not bill E/M service if only signs and symptoms are related to the NCS: 95905 (Motor and/or sensory nerve conduction…). According to a local coverage determination (LCD) from Part B Medicare contractor WPS, “An E&M service is included in the exam performed just prior to and during nerve conduction studies and/or electromyography. If the E&M service is a separate and identifiable service, the medical record must document medical necessity and the CPT® code must be billed with a modifier 25.”
To report the E/M separately, your physician should obtain a history, exam, and MDM for a separately identifiable service. If documentation supports the separate E/M code, report the proper code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) attached.
Resource: You can read the WPS LCD at downloads.cms.gov/medicare-coverage-database/lcd_attachments/31346_6/L31346_NEURO005_CBG_010112.pdf.
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