Neurology & Pain Management Coding Alert

Payer policies are your key to reimbursement. 

Autonomic nervous system (ANSAR) testing is a relatively new procedure for neurologists, but can be a payable service – if you meet certain criteria. Read on for the lowdown on filing a successful claim. 

Get Familiar With the Codes

The most reasonable and recommended CPT® code for ANSAR testing is 95943 (Simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced [deep] breathing, Valsalva maneuvers, and head-up postural change). However, ensure before reporting the code that your provider’s documentation indicates that both the sympathetic and parasympathetic function testing were performed as identified by the code’s descriptor. 

Also note: Not just any physician can report this service. It requires proper certification. 

According to Novitas Solutions, “Physicians must have knowledge, training, and expertise to perform and interpret these tests, and to assess and train personnel working with them. This training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program or must reflect extensive continued medical education activities. If these skills have been acquired by way of continued medical education, the courses must be comprehensive, offered or sponsored or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States, and designated by the American Medical Association (AMA) or American Osteopathic Association (AOA) as category I credit.”

Coding edits bundle 95943 with several related procedures, meaning you cannot bill the services together: 

• 93040 – Rhythm ECG, 1-3 leads; with interpretation and report

• 95921 – Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio

• 95922 – Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt

• 95924 – Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt.
  

If your physician performs any of these procedures during the same encounter as an ANSAR test, only report 95943. 

Check With Payers for Coverage Info

Many Medicare contractors have local coverage policies for Autonomic Function Testing, which include the criteria for coverage for these diagnostic tests. Some commercial payers might accept 95943, but others consider ANSAR testing to be experimental and investigational. 

Aetna, for example, “considers ANSAR (ANX 3.0) test experimental and investigational in the evaluation of paradoxical parasympathetic syndrome because its clinical value has not been established,” according to its policy number 0485. If a payer takes this stance, you won’t be reimbursed for the service. 

First step: Review the patient’s insurance coverage to determine whether you’ll be reimbursed for the test. If not, notify the patient of non-coverage prior to the testing being performed. 

Look up your state’s Local Coverage Determination (LCD) for ANSAR testing, because Medicare has strict stipulations for billing the procedure. There’s not a published fee schedule (or associated RVUs) for 95943, so you’ll need to discuss that with your individual payer. 

ANSAR explained: Our body’s autonomic nervous system is divided into two parts: the parasympathetic (digestion, healing, blood flow and respiration) and the sympathetic (“fight or flight” response). When there is an imbalance in the autonomic nervous system, there is a reason. ANSAR testing can detect many conditions in the early stages, when treatment can be most effective. Conditions such as cardiovascular disease (420-429), diabetes (250.xx), Parkinson’s disease (332.x), multiple sclerosis (340), chronic fatigue syndrome (780.71), and high blood pressure (401.x) can be identified and measured with the ANSAR test. 

ANSAR is a non-invasive test that measures heart rate variability, respiratory activity, and blood pressure readings during different situations. Analysis of this data gives physicians information about the patient’s bodily functions that are not obtainable in any other way.