Neurology & Pain Management Coding Alert

Question: What is the proper use of modifier -59 for an EMG/NCS with F-wave study, sensory and motor at the ulnar and median wrist nerves?

Florida Subscriber

 
Answer: Code 95903 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) specifies "with F-wave study" and should, therefore, not be reported with 95900 (... without F-wave study). The national Correct Coding Initiative (CCI) bundles 95900 into 95903. If, however, one nerve is tested without F-wave study and a different nerve is tested with F-wave study, report both 95900 and 95903, with modifier -59 (distinct procedural service) appended to the latter to indicate that a different location was tested.
 
In your case, 95903 is performed on two different nerves, the ulnar and median nerves. Report this as 95903 and 95903-59. Also, enter the phrase "ulnar and median nerve" in the text box on the claim form to explain the use of the modifier.
 
The medical record must clearly document medical necessity for the test. Data gathered during the nerve conduction study (NCS), such as the actual numbers (latency, amplitude, etc.) -- preferably in a tabular (not narrative) format -- should be included. The reason for the referral and a clear diagnostic impression are required for each study.
 
For needle electromyography, or EMG (95860-95864), bill only one unit of service to cover all muscles tested, including the related paraspinal muscles and recording of motor unit recruitment and amplitude and configuration, both at rest and with muscle contraction. Code 95870 (needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) should be used to bill a limited EMG study of specific muscles. Examinations confined to distal muscles only, such as intrinsic foot or hand muscles, should also be reported with this code.
 
According to information published in the Federal Register, a minimum of five muscles must be studied to bill 95860-95864 -- for example, when extremity muscles are innervated by three nerves (e.g., ulnar, median, tibial, peroneal or femoral; not sub-branches) or when four spinal levels are evaluated.
 
When fewer than five muscles per extremity are examined (e.g., when examining muscles on the thorax or abdomen [unilateral or bilateral]), report 95870. One unit may be billed for studying cervical or lumbar paraspinal muscles (unilateral or bilateral), regardless of the number of levels tested. Do not use this code when the paraspinal muscles corresponding to an extremity are tested and when the extremity codes 95860-95864 are also billed.