Neurology & Pain Management Coding Alert

Key: Count required units and append modifiers to avoid denials.

When reporting nerve conduction studies (NCS), you can avoid denials by reporting the correct number of units and appending the needed modifiers. Four factors govern your code choice:

• which nerve was tested;
• how many nerves in total were tested;
• whether the physician completed an F-wave study; and
• if any pre-configured devices were used.

Check out our advice below on rightful NCS reporting and put an end to your denials for these procedures.

1. Identify the Motor or Sensory Nerve

When your neurologist performs a nerve conduction test, first determine if he tested a motor or sensory nerve. CPT® gives you different choice of codes for the two types.

For motor nerve testing, report 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) or 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study), depending upon whether the F-wave study was done.

For sensory nerve testing, report 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory).

2. Count the Nerves Tested

Pay close attention to the diagnostic study report to determine how many nerves your neurologist tested. Remember that your neurologist may actually have performed the testing at multiple sites on the same nerve. In this case, you will report only one and not multiple nerves.

"Appendix J of the CPT® codebook is extremely helpful in distinguishing between testing of separate nerves versus testing on multiple sites of a single nerve," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO. "It lists the individual branches of motor, sensory and mixed nerves, with each listing representing a separate and distinct nerve conduction study. For example, sensory nerve conduction study (NCS) of the median sensory nerve to the second digit with testing at both the mid-palm and wrist would constitute a single study; whereas sensory NCS testing of the median sensory nerve to the second digit and ulnar sensory nerve to the fifth digit constitutes two separate diagnostic studies and each NCS would be reported with a unit of service."

Note: The CPT® descriptors for codes 95900, 95903, and 95904 mention 'each nerve.' This implies that you report a single unit of these codes for every nerve tested. You will not report multiple units of these codes if your neurologist does the testing at multiple sites on a single nerve.

3. Bill the Professional Component

You append modifier 26 (Professional component) to indicate that your physician did only the interpretation and reporting when billing for the NCS codes 95900-95904. "All of the electrodiagnostic studies, including nerve conduction study codes 95900-95904 have professional and technical components," says Hammer. "If the neurologist is only performing the professional interpretation of nerve conduction studies performed by a non-employee technician, then the neurologist would likewise only bill with modifier 26 also."

Editor's Note: For more steps in reporting the nerve conduction studies, see the next issue of Neurology Coding Alert, Vol. 14, No. 11.