Neurology & Pain Management Coding Alert

EP studies measure the brain's electrical activity in response to stimulation of specific nerve pathways, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. The neurologist uses this information to diagnose nerve disorders, multiple sclerosis and other conditions; to locate damaged nerves; or to evaluate a patient's condition during surgery or following treatment.

Question 2: What Distinguishes a Comprehensive Audio Study?

Answer 2: To report a comprehensive auditory evoked response (AER) exam (92585), the neurologist must measure middle latency and late cortical responses and evaluate brainstem response, says Debra Abel, AuD, owner of Alliance Audiology, in Alliance, Ohio. By combining these three types of auditory EPs, the physician can evaluate the status of several areas of the central auditory nervous system (for example, auditory periphery and brainstem, pathways between midbrain, etc.).

A limited audiometry examination (92586) describes limited auditory brainstem response (ABR) testing used primarily in infant screening evaluations. The physician obtains and replicates the AER screening at one or two levels for each ear only, rather than the three levels necessary to report 92585, Abel says.

Question 3: How Should I Code Multiple Skin Sites?
 
Answer 3: Regardless of the number of skin sites (dermatomes) the neurologist tests during sensory EPs, you may report only a single unit of 95925-95927, as appropriate to the body area the neurologist studies, Busis says.

Example 1: The neurologist tests three skin sites each on the left and right arms. You should report 95925.

Example 2: The neurologist tests a single dermatome on the left and right thigh. Report one unit of 95926.

Beware of unilateral testing: Although the descriptors for 95925-92927 do not specify a minimum number of testing sites, these codes do indicate a bilateral procedure. Therefore, if the neurologist studies dermatomes on one side of the body only, you must append modifier -52 (Reduced services) to the appropriate sensory EP study code, according to CPT Assistant, April 2002.

Example 3: The neurologist studies six dermatomes at various locations on the left leg. In this case, you must report 95926-52 to indicate that the neurologist performed a unilateral study.

Question 4: Can I Report More Than One Kind of Study on the Same Day?
 
Answer 4: Yes. Although you may report multiple sites tested using the same study only once, you may report multiple types of EP studies separately on the same day. And, you may claim EP studies separately reportable as baseline studies during intraoperative monitoring, says Tiffany Schmidt, JD, policy director for the American Association of Electrodiagnostic Medicine.

For example, the neurologist provides intraoperative monitoring using EP studies during surgery for scoliosis (737.3x). If the physician tests both upper and lower limbs, report 95925 and 95926 as well as +95920 (Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]), times the number of hours of monitoring (for example, 95920-26 x 2 for two hours of monitoring).

Question 5: What About Monofilament Testing?

Answer 5: CPT does not contain a dedicated code to describe monofilament sensory testing for peripheral neuropathy. The service is not separately billable, and you should include monofilament testing (which does not include recording from the central nervous system) as a part of any E/M service the neurologist provides on the same date of service, Busis says.

Warning: You should not use 95925 or 95926 to report monofilament nerve testing to evaluate peripheral neuropathy. Most likely, the payer will deny the claim. But even if you receive reimbursement, you could face trouble later in an audit.

Example: The neurologist examines a diabetic patient for loss of protective sensation (LOPS). To establish a diagnosis, the neurologist tests five sites on the plantar surface of each foot using a 5.07 Semmes-Weinstein monofilament. In this case, you should report the E/M code best supported by the physician's documentation (for example, 99243, Office consultation for a new or established patient ...), with no separate code to describe the monofilament testing.

Don't make this mistake: Never bundle sensory EP studies as described by 95925-95927 to E/M services, or you will unjustifiably forfeit about $60 in payment.

Question 6: Can I Report an E/M Service on the Same Day as an EP Study?

Answer 6: Yes, but you may not automatically report an E/M service when the physician provides an EP study. If the neurologist provides a significant, separately identifiable E/M service on the same date as the EP study, you may report the appropriate E/M service appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

For example, an established patient with suspected multiple sclerosis (340) arrives for a scheduled visit. During the visit, the neurologist reviews the results of a previous MRI, which are not definitive. To gather further evidence, the neurologist also conducts EP testing during the same visit.

Because the testing is separate and distinct from the E/M service, you may report both codes, with modifier -25 appended to the E/M service code (for example, 99213-25, 95927), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc.  in Brick, N.J.

Bonus Tip: Don't Forget Modifier -26

All EP studies include recording, physician interpretation and report. Therefore, if the neurologist provides interpretation only (the neurologist does not use his own equipment or administers the EP in a hospital), you must append modifier -26 (Professional component) to any EP studies reported.