Neurology & Pain Management Coding Alert

Report 95900, 95903 and/or 95904 only once when you stimulate multiple sites on the same nerve

If denials for nerve conduction studies (NCS) have left you a little unnerved, you-ll soon be able to look to CPT 2006 to make your job easier. 

The AMA will include an -Appendix J- in CPT 2006 listing which nerves count as separate -units.- With this list of separately reportable procedures in hand, you can easily identify the correct type and number of NCS codes to report.

Report 1 Unit per Listed Nerve 

For each separately reportable nerve you test, you may report one unit of service of the corresponding NCS code, 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 AMA has arranged the list of nerves by type (motor or sensory/mixed) and location (upper extremity, lower extremity, cranial nerves and trunk, and root stimulation).

Free resource: For a quick and convenient list of separately billable nerves, see -Clip and Save: Keep This List Handy for Easy NCS Coding- later in this issue.
 
-I think this method should make billing for NCS much easier for most coders,- Busis says. -Determining the correct number of separately billable studies should now be as simple as consulting a list.-

Warning: The number of studies does not necessarily equal the number of units, says Tiffany Schmidt, JD, policy director for the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). If you stimulate and record multiple sites on the same nerve, you should only report one unit of the appropriate NCS code.

Make Your Case With Modifiers When Mixing Studies

You can report more than one type of NCS at the same time--and even multiple units of each type of study--as long as each study occurs on a separately billable nerve and you meet medical-necessity requirements for the services provided.

Suppose you provide study with F-wave on the ulnar nerve to the abductor digiti minimi, study without F-wave on the ulnar nerve to the first dorsal interosseous, and a study on the ulnar dorsal cutaneous sensory nerve.

In this case, if you check the list of nerves, you find that each of these nerves counts as a separate unit. Therefore, you should report 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) for the ulnar nerve to the first dorsal interosseous, 95903 (- motor, with F-wave study) for the ulnar nerve to the abductor digiti minimi, and 95904 (... sensory) for the ulnar dorsal cutaneous sensory nerve.

If you stop your coding there, however, don't be surprised to see reduced reimbursement. Many carriers will look at the claim and think you-re trying to bill multiple motor studies for the same nerve, Busis says. Appending modifier 59 (Distinct procedural service) to the lesser study, 95900, can help to clarify to your payer that the motor tests occurred on separate nerves.
 
Brush Up on Your NCS Frequency Guidelines

When reporting multiple NCS units or testing the same patient on multiple occasions, you also need to be aware of payers- use and frequency guidelines.

Payers limit the maximum number of NCS units they will reimburse for a given diagnostic category. Generally, payers abide by the AANEM's -Recommended Policy for Electrodiagnosic Testing,- which includes a chart listing the -maximum number of tests necessary in 90 percent of cases- for a variety of diagnostic categories and electro-diagnostic tests.

Example: The AANEM's policy states that a minimal evaluation for radiculopathy -includes one motor and one sensory NCS and a needle EMG [electromyography] examination of the involved limb- but that testing can include -up to three motor NCSs (in cases of an abnormal motor NCS, the same nerve in the contralateral limb and another motor nerve in the ipsilateral limb can be studied) and two sensory NCSs.-

Learn more: For complete information on frequency guidelines, see -More Isn't Necessarily Better for EDX Testing- and -Watch Your Claims Frequency for EDX Testing,- Neurology Coding Alert, July 2005.

Seal the Deal With Documentation

When conducting NCS, be sure to record each nerve or nerve branch you study. Not only will this make finding the number of billable units easier for staff members following up on the claim, but payers will also look for this information when processing. For instance, without evidence of testing on two separate nerves, insurers are likely to reject multiple units of the same code (for instance, 95904 x 2) as a duplication of services.

In addition, the AANEM recommends documenting the distance between the stimulation and recording sites, the conduction velocity, latency values and amplitude for each study, Schmidt says.