Neurology & Pain Management Coding Alert

CMS has announced a number of changes to the 2002 Physician Fee Schedule. Among them is an increase in the number of allowable relative value units (RVUs) assigned to nerve conduction study (NCS) code 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study).

Due to "various inconsistencies" in the 2002 Physician Fee Schedule, which determines Medicare payments for physician services, CMS released a program memorandum, transmittal AB-02-018 (change request 2036) dated Feb. 8, 2002, to update the fee schedule. The most significant change is an increase in RVUs for 95903, which had been assigned fewer RVUs (1.15 versus 1.18 fully implemented nonfacility total RVUs) than 95900 ( motor, without F-wave study). This was particularly confusing because 95900 is bundled to 95903 by the national Correct Coding Initiative when studies with and without F-waves are performed on the same nerve. In effect, the neurologist would be paid less to perform the more extensive procedure.

The revision raises the physician work value for 95903 by 0.3 RVUs (to 0.81 RVUs), raising the total RVUs for the procedure to 1.45, or about $52. With modifier -26 (Professional component) appended, payment falls to about $32 per unit of 95903 reported (versus about $23 per unit of 95900 reported). According to the memo, the change in payment rates will take effect on April 1, 2002.

In addition, motion analysis codes 96000-96004 have been revised to indicate that the procedures are inherently bilateral and therefore should not be reported with modifier -50 (Bilateral procedure).

Note: To view CMS program memorandum, transmittal AB-02-018 (change request 2036), visit the CMS Web site at www.hcfa.gov/pubforms/transmit/AB02018.pdf. Adobe Acrobat Reader is required to open the file. You may download the software from www.codinginstitute.com at no charge.