Neurology & Pain Management Coding Alert

Report testing per extremity, not per individual site

The AMA will designate five new Category III codes to describe quantitative sensory testing (QST) for 2006. The new codes will make reporting QST much easier and could lead to wider acceptance of this testing protocol and the eventual establishment of permanent, Category I codes.

Dump the Unlisted-Procedure Code

Now, you must report QST using unlisted-procedure code 95999 (Unlisted neurological or neuromuscular diagnostic procedure). Beginning Jan. 1, 2006, however, you will be able to choose from among five new Category III T codes--as appropriate to the type of stimulation the neurologist uses--to describe QST (note that the AMA has not yet designated the third and fourth digits for these codes):

- 00xlT--Quantitative sensory testing (QST), testing and interpretation per extremity; using touch pressure stimuli to assess large diameter sensation

- 00xmT---using vibration stimuli to assess large diameter fiber sensation

- 00xnT---using cooling stimuli to assess small nerve fiber sensation and hyperalgesia

- 00xoT---using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia

- 00xpT---using other stimuli to assess sensation.

What is QST? QST measures sensations mediated by different kinds of nerve fibers, such as vibrotactile sensations mediated by large nerve fibers, cooling sensation mediated by medium-size nerve fibers, warm sensation mediated by small nerve fibers, and heat- and cold-evoked pain sensations mediated by the smallest nerve fibers. QST is noninvasive and generally painless. In some cases, QST can provide more sensitive measurements than standard tests such as sensory-evoked potential (95925-95927) or nerve conduction (95900-95904) studies.

QST can be an important tool for detecting and characterizing sensation, says Peter J. Dyck, MD, director of Peripheral Nerve Research Laboratory at the Mayo Clinic in Rochester, Minn. Specifically, QST is useful in formulating a differential diagnosis of neurologic disease--especially peripheral neuropathy--and detecting hyperfunction of sensory receptors or nerve fibers.

Count Extremities, Not Test Sites

As indicated in the descriptors for 00xlT-00xpT, you will report QST procedures per extremity, not per individual test site.

Example: The neurologist uses vibration stimuli to check sensation of a diabetic patient's left foot.

In this case, because the neurologist tests only one extremity, you should report a single unit of 00xmT.

Different stimuli mean different tests: If the neurologist uses more than one type of stimulation, even on the same limb, you can report separate code units to describe each type of stimulation.

The examiner may typically conduct three separate tests at a single site, Dyck says, using test touch-pressure and/or vibration for large fiber sensation, cooling sensation for intermediate sensory fiber dysfunction, and heat-pain for small fiber dysfunction.

Example: Returning to the example above, the neurologist tests several sites of the left foot with vibration stimuli, but also assesses small-nerve sensation using cooling stimuli. In this case, you should report both 00xmT and 00xnT.

Dedicated Codes Provide Benefits

When submitting a claim with an unlisted-procedure code, you must file manually and include documentation that describes the procedure thoroughly, says Heather Corcoran, coding manager at CGH Billing Services, a medical billing firm in Louisville, Ky. This means more work for the coder and, because insurers don't establish -standard- fees for unlisted-procedure codes, may still result in less-than-satisfying reimbursement.

Having a dedicated code--even a Category III code--to report a procedure allows for straightforward coding and documentation and allows payers to establish standard reporting guidelines and payment schedules.

The bad news: Most payers will not reimburse for Category III codes.

Important: AMA guidelines stress, -If a Category III code is available, this code must be reported instead of a Category I unlisted code- [emphasis in the original].