Neurology & Pain Management Coding Alert

Question: Some payers consider autonomic testing codes (95921, 95922 and 95923) to be mutually exclusive. Is this true? Can I report more than one test on the same day?

Maine Subscriber

 
Answer: CMS recently revised its policy. Until Nov. 1, 2001, autonomic testing codes 95921 (Testing of autonomic nervous system function; cardiovagal innervation [parasympathetic function], including two or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio), 95922 ( vasomotor adrenergic innervation [sympathetic adrenergic function], including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least five minutes of passive tilt) and 95923 ( sudomotor, including one or more of the following: quantitative sudomotor axon reflex test (QSART), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential) were bundled. The codes describe different tests, however, and with the release of version 7.3 of the national Correct Coding Initiative (CCI) CMS acknowledged that there are situations in which it is medically necessary to report all three on the same day.
 
Note: Deletions of the mutually exclusive code edit that bundled autonomic nervous system function testing before Nov. 1, 2001, are retroactive. Claims that were denied prior to the release of CCI 7.3 may be resubmitted to local carriers for adjustment. 
 
One unit each of 95921, 95922 and/or 95923 can be billed for the same patient on the same day if documentation supports medical necessity. However, several payers, including some Medicare carriers, consider these tests to be investigational and may not reimburse appropriately. Ask your individual payer for its policy.
 
  Clinical and coding expertise for You Be the Coder and Reader Questions provided by 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;  Laureen Jandreop, OTR, CPC, CCS-P, CPC-H, CCS, A+ Medical Management and Education, Absecon, N.J; and Marc Nuwer, MD, PhD, chief of clinical neurophysiology at Reed Neurological Research Center, Los Angeles.