Neurology & Pain Management Coding Alert

All of the above studies include recording, physician interpretation and report. Therefore, if the neurologist provides interpretation only (the neurologist does not use his or her own equipment or the EP is administered in a hospital), modifier -26 (Professional component) must be appended to any EP studies reported. If the neurologist performs upper and lower somatosensory EPs as a preoperative study in the office, report 95925 and 95926 with no modifier because you are billing for the total service, not the professional component alone.

Codes 92585 and 92586 describe auditory EP studies, in which electrical recordings are made in response to auditory stimulations from electrodes placed on the scalp.

Code 92585 was revised in CPT 2001 to clarify the intent of this procedure for the performance of a comprehensive auditory evoked response (AER) exam, according to 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 comprehensive AER exam includes middle latency and late cortical responses, as well as evaluation of brainstem response," he says. "By combining these three types of auditory EPs, the status of several areas of the central auditory nervous system [e.g., auditory periphery and brainstem, pathways between midbrain, etc.] is evaluated." Similarly, 95826 was added in 2001 to describe a limited audiometry examination and is intended to report limited auditory brainstem response (ABR) testing used primarily in infant screening evaluations, Busis notes. The ABR screening is obtained and replicated only at one or two levels for each ear (as opposed to three, as necessary for 92585).

Use of 95925-95927 is easily discernable by the body area tested, although there is some confusion about the number of units of 95925-95927 that can be reported when multiple nerves or dermatomes (skin sites) are stimulated in a given limb.

In all cases, only a single unit of 95925 may be reported, regardless of the number of nerves or dermatomes that are stimulated in each upper limb (on one or both sides). By the same token, only one unit of 95926 can be used regardless of the number of nerves or dermatomes that are stimulated in each lower limb (on one or both sides). In all cases, there is no minimum number of sites that must be tested, although CPT specifically defines these codes as bilateral, and therefore modifier -52 (Reduced services) must be used for unilateral studies.

Although multiple sites tested using the same study may only be reported once, multiple types of EP studies may be reported separately on the same day. In addition, EP studies are separately reportable as baseline studies during intraoperative monitoring.

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

Note: For complete information on intraoperative monitoring, see Neurology Coding Alert, January 2002.

As is true of other diagnostic tests, the neurologist may not automatically report an E/M service (e.g., 99213, Office or other outpatient visit for the evaluation and management of an established patient ) when providing an EP study(s). If a significant, separately identifiable E/M service is provided at the same time, however, it may be reported by appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code.

For example, a patient with suspected multiple sclerosis (340) arrives for a scheduled office visit. Because previously administered MRI results are equivocal, the neurologist provides EPs during the visit for further testing. In this case, the testing is separate and distinct from the visit (although the visit to review the results of the MRI did prompt the test), and both the appropriate EP code (e.g., 95925) and the appropriate E/M service code (e.g., 99213) may be reported as long as modifier -25 is appended to the E/M code.