Neurology & Pain Management Coding Alert

Verify total nerves tested, get specific for preconfigured devices.

If you find reporting nerve conduction studies (NCS) especially problematic when your neurologist performs multiple and/or bilateral nerve testing, knowing how to report each unit of testing and work with bundles and modifiers could ease your coding -- and speed the way to smooth claims for these services. .

1. Watch for NCS Bundles

According to National Correct Coding Initiative (CCI) edits, you can't bill both 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) and 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) for conduction study on the same motor nerve. Code 95900 is a column 2 code for the more extensive column 1 code 95903. When you can legitimately report both codes, append a modifier to 95900 to differentiate the services provided.

Example: If you read that your neurologist did nerve conduction testing on the median nerve (motor) to the abductor pollicis brevis (ABP) on the left hand and then did an F-wave study on the same nerve, you will only report a single unit of 95903. You do not separately report the regular 95000 as this code is bundled into the more comprehensive 95903.

2. Append Modifier 59 for Multiple Tests

You may need to append modifier 59 (Distinct procedural service) in some situations when your neurologist does multiple conduction studies or tests different nerves. This will help you recoup your deserved payment for each unit of testing when your neurologist does a motor NCS on one nerve and a separate and distinct motor NCS with F-wave study on another nerve.

Example: Your neurologist performs a motor NCS without F-wave on the right ulnar motor nerve to the abductor digit minimi (ADM) muscle and a motor nerve conduction study with F-wave on the right radial motor nerve to the extensor digitorum communis (EDC) muscle. You'll report 95900 and 95903 for the two procedures, respectively. Append modifier 59 (Distinct procedural service) to 95900 to clarify that your neurologist performed separate conduction studies on different nerves.

Very often, you'll face a challenge of reporting multiple conduction tests in more than one nerve. Be sure to verify the total number of nerves your neurologist tested.

Example: Your neurologist performs a motor nerve testing in the right hand for the following:

• Median nerve to APB;
• Ulnar nerve to ADM;
• Radial nerve to EDC;
• F-wave study on median nerve to APB; and
• F-wave study on ulnar nerve to ADM.

In this case, report 95903 for two units of testing done for median nerve to the APB and ulnar nerve to the ADM, plus one unit of 95900-59 for testing radial nerve to the EDC. List 95903 on the first line of the claim as this is a more comprehensive code.

Tip: Do not append modifiers 50 (Bilateral procedure) or 51 (Multiple procedures) when reporting any of the NCS codes. Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO. states, "Per the Medicare Physician Fee Schedule, the 95900-95904 codes carry the '0' bilateral indicator or '150% payment adjustment for bilateral procedures does not apply.' It would not be appropriate to append modifier 50 to one of these NCS codes even if the same nerve was tested on the contralateral limb. Instead, you would report the conduction testing on the contralateral limb as an additional unit of service of the corresponding NCS code. Likewise, all three of these codes have the symbol in front of the code listing in the CPT® codebook. This specifies that these codes are modifier 51 exempt and should not be reported with modifier 51."

3. Turn To 95905 for Preconfigured Devices

If your neurologist uses a portable nerve conduction test device with a preconfigured biosensor array, submit code 95905 (Motor and/or sensory nerve conduction, using preconfigured electrode array[s], amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report). The descriptor clearly specifies that you can use the code for both motor and/or sensory nerve conduction and that the code includes F-wave study when performed.

Also note that you report 95905 for each limb tested -- not for each nerve tested as you do for 95900-95904 (Nerve conduction, amplitude and latency/velocity study, each nerve...).

Example: Your neurologist tested the median and the ulnar nerve conduction in the left hand using a preconfigured array. Report only a single unit of 95905 despite having two nerves tested. This is because both the nerves being tested are in the same arm, and 95905 applies to each limb tested.

Note: Don't submit 95905 with any other nerve conduction study codes from 95000-95904. Also steer clear of reporting 95905 with muscle testing codes such as:

• 95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure])
• 95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure])
• 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle)
• 95936 (H-reflex, amplitude and latency study; record muscle other than gastrocnemius/soleus muscle)

4. Bill the Professional Component

As in the case of NCS codes 95900-95904, you bill the professional component when reporting 95905.The descriptor for 95905 also specifies that the code includes interpretation and reporting of the nerve conduction testing. However, your physician may only provide the services to interpret a test done elsewhere. In this case, append modifier 26 (Professional component) to 95905 to indicate that your physician did only the interpretation and reporting. The use of a preconfigured device may not need the on-site presence of the physician.

"The Medicare Physician Fee Schedule indicates that the technical component of 95905 requires only general supervision by the physician," says Hammer. "Per Medicare, general supervision means the procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. Under general supervision, the training of the nonphysician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician."

5. Report the Supporting Diagnosis

Make sure you also report the appropriate diagnosis code(s) that necessitate your neurologist to perform the conduction study. "The ICD-9-CM Guidelines directs coders to report -- For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses," says Hammer. When the neurologist indicates that the nerve conduction studies are normal, you would report the patient's presenting signs and/or symptoms, such as numbness, tingling, weakness, or loss of sensation as the reason for performing the diagnostic studies.

Some common diagnosis codes for patient signs and symptoms that you may report with NCS include 728.87 (Muscle weakness [generalized]), 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified), 781.2 (Abnormality of gait) or 782.0 (Disturbance of skin sensation).