Neurology & Pain Management Coding Alert

A number of important limitations dictate proper reporting of evoked potential (EP) studies. By knowing how many units of a particular EP code you can claim per day and when to claim separately reportable studies, you can minimize coding mistakes and improve reimbursement. Codes to Consider and Procedures to Ponder EP studies measure the brain's electrical activity in response to stimulation of specific nerve pathways. The neurologist uses this information to diagnose nerve disorders, multiple sclerosis and other conditions; to locate damaged nerves; or to help evaluate a patient's condition during surgery or following treatment. CPT contains six codes to describe EP studies, which may be classified as auditory, somatosensory (SEP) or visual:

92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive 92586 limited 95925 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs 95926 in lower limbs 95927 in the trunk or head 95930 Visual evoked potential (VEP) testing central nervous system, checkerboard or flash. 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. Now Hear This:92585 and 92586 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 [...]