Neurology & Pain Management Coding Alert

Question: How should I bill for quantitative sensory testing?

Maine Subscriber

Answer: Quantitative sensory testing (QST) describes a set or type of tests that 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, which are mediated by the smallest nerve fibers. QST procedures are noninvasive and do not involve needles or electric shocks. They are generally painless, except when testing heat- and cold-evoked pain sensations (which produces a sensation similar to a pin prick to the finger). Some tests of this type are considered more sensitive than sensory-evoked potential (95925-95927) or nerve conduction (95900-95904) studies in that they provide information about sensations mediated by even the minutest nerve fibers.

Because the procedures are not fully developed, CPT does not contain a code for QST. The American Association of Electrodiagnostic Medicine and the American Academy of Neurology are working on position papers regarding these technologies. When the testing is more developed, it is likely that a CPT code (or family of codes) will be requested. In the meantime, some providers have successfully coded 95999 (Unlisted neurological or neuromuscular diagnostic procedure) with a report and a form letter explaining QST and its benefits. The letter should describe the amount of work involved in the procedure by comparing it to other, similar diagnostic tests (e.g., evoked potentials) so the insurer can make an educated decision concerning proper reimbursement.

Remember that Medicare has specifically rejected coverage for electrodiagnostic sensory nerve-conduction threshold (sNCT) studies to diagnose sensory neuropathies using the Current Perception Threshold machine by Neurotron, determining "that the available evidence is not adequate to reliably conclude that sNCT is reasonable and necessary for the diagnosis of sensory neuropathies because it is not clinically effective."

Note: For more information on CMS' coverage decision for sNCT, visit the CMS Web site at http://www.hcfa.gov/coverage/8b3-ccc2.htm.

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 for the department of neurology at the University of Pittsburgh School of Medicine; and Laureen Jandreop, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Egg Harbor City, N.J.