Neurology & Pain Management Coding Alert

Question: The physician performs a nerve conduction study (95904) from digit II with ring electrodes, stimulating at the wrist. Because of a need for further clarification, he also stimulates at the palm while recording with a block lead at the wrist. May I report two separate charges?

New Hampshire Subscriber

Answer: The rule of thumb is, if either the recording or stimulating electrode remains stationary during testing, you may report only a single unit of the appropriate nerve conduction study code. For example, the neurologist tests the median sensory nerve to the third digit, then moves the stimulating electrode while recording on the same nerve. In this case, because he or she moved only the stimulating electrode, you may report only a single unit of 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory).

But if the physician moves both the recording and stimulating electrodes, even to different locations on the same nerve, you may report multiple units. In the above question, for instance, the neurologist moves both electrodes. These tests represent two different nerve conduction studies: The first is a digital sensory nerve conduction study (wrist-digit), and the second is a median mixed-nerve conduction study (palm-wrist). Therefore, you may report 95904 x 2. Documentation should clearly outline the exact location of the electrodes so the payer does not deny the claim as redundant.

As an alternative to the "moving electrodes" rule, you may consult the American Academy of Electrodiagnostic Medicine (AAEM) "list of nerves," which the AMA has also adopted. If the studies you wish to bill are listed separately on the list of nerves, the studies qualify as separate studies and you may report them accordingly.