Neurology & Pain Management Coding Alert

CPT 2000 limits the use of codes for nerve conduction studies to only once when a neurologist stimulates multiple sites on the same nerve. To avoid claim denials for excessive frequency when billing these procedures, physicians must be able to show medical necessity.

Although most patients who need nerve conduction studies (95900, 95903, 95904) do not need them on a repeat basis, approximately 5 to 10 percent do. For example, a neurosurgeon may request a nerve conduction study done right after the surgery and again six months later to compare nerve loss at different points over time. The neurologist must then perform the procedure twice, testing different areas for nerve growth.

According to CPT 2000, the applicable codes are:

- 95900nerve conduction, amplitude and latency/ velocity study, each nerve; motor, without F-wave study,

- 95903nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study, and

- 95904nerve conduction, amplitude and latency/ velocity study, each nerve; sensory or mixed.

Importantly, the new CPT contains guidelines pertaining to these codes that state physicians should report each of the nerve conduction codes only once when multiple sites on the same nerve are stimulated or recorded. In CPT 1999, these codes are specifically for any/all site(s) along the nerve. The new language clarifies that neurologists are to count only one unit even when multiple areas along the same nerve are stimulated.

The other big change in CPT 2000 for nerve conduction codes is that 95904 is now for sensory or mixed (sensory and motor) studies. In CPT 1999, 95904 was for sensory only.

Know Local Medicare Frequency Limits

Neurologists also should remember that there are limits on the number of nerve conduction studies they may bill for one patient. These limits depend on local Medicare carrier policies. Neurology coding experts say that regardless of the number of studies you must do, the key to getting reimbursed for the procedure is to document the medical necessity in the patients chart
for each.

Claims for excessive frequency may be denied, says Deborah Werner, CPC, reimbursement specialist for neurology at the Cleveland Clinic Foundation in Cleveland, Ohio. The medical record should reflect signs and symptoms and the differential diagnosis in the case of repeat nerve conduction studies. Neurologists may not bill for repeat nerve conduction studies when a patient, such as a diabetic, is stable if there is no change in his or her condition, she notes.

Our carrier only allows four nerve conduction studies a year, says Douglas M. Loop, CPA, administrator of Loma Linda Neurology Associates in Loma Linda, Calif. We dont have to do repeat studies very often, but when we do, its necessary, he notes. For example, a patient suffering from amyotrophic lateral sclerosis (ALS) commonly undergoes four motor and four sensory nerve conduction studies a year, says Loop. Its a long exam, so we dont get paid for all the work we doeven if its clinically a good idea.

The only way neurologists can ensure that they are being reimbursed properly for this procedure is to contact the medical director for their regional carrier and to appeal denials. We did this, and we won, says Loop.