Neurology & Pain Management Coding Alert

Question: Our neurologist conducted a nerve conduction study on a patient's upper limbs one day, and on the patient's lower limbs a few days later. We reported 95903 and 95904 for each day, according to the number of nerves he tested. Medicare paid for the first day's tests but denied the second day's tests. How can we avoid denials in the future?

New Hampshire Subscriber
Answer: You reported the test with the correct codes of 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) and 95904 (... sensory).
 
Giving a specific answer to your question is difficult without knowing the reason for Medicare's denial. Keep these points in mind as you work through the process:

- Medical necessity: Look at the diagnosis code your neurologist reported to be sure it supports the test. Carriers often accept diagnoses such as 356.2 (Hereditary sensory neuropathy) or 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified). You should be able to check your carrier's local coverage policy to verify acceptable diagnoses. Note: Don't fall into the trap of reporting a diagnosis because the carrier will pay for it, if it doesn't apply to the case. Always submit the most accurate diagnosis, regardless of the carrier's policy.
 
- Test quantity: CPT's Appendix J includes a table explaining the maximum number of studies physicians need to arrive at a diagnosis in 90 percent of patients. If the number of diagnostic studies your neurologist performed exceeds the numbers in the table, your carrier will want additional documentation to show why your physician needed to perform so many tests. 

- Nerve sites: 95903 and 95904 are -each nerve- codes, but there is an exception to this part of the descriptor. According to CPT's parenthetical note just below the codes, you -report 95900, 95903 and/or 95904 only once when multiple sites on the same nerve are stimulated or recorded.- Be sure you-re following this guide and not reporting multiple sites on the same nerve as -each nerve.-

- Documentation: If your neurologist exceeded the maximum number of studies in Appendix J, be sure his documentation supports compliant use of the codes and the need to perform that quantity. If so, appeal to Medicare with complete notes explaining the situation.