Neurology & Pain Management Coding Alert

Question: A colleague of mine recently informed me that Medicare is providing additional payment for nerve conduction study (NCS) claims already filed. Is this true? What are the details?

Florida Subscriber

Answer: As reported in the June 2002 Neurology Coding Alert, CMS issued program memorandum, transmittal AB-02-18 (change request 2036), dated Feb. 8, 2002, to correct "various inconsistencies" in the 2002 Physician Fee Schedule, which determines Medicare payments for physician services. Among the changes was an increase in the number of relative value units (RVUs) assigned to 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study). Prior to the revision, CMS had assigned 95903 fewer RVUs than 95900 ( motor, without F-wave study), which is a less-extensive procedure.

The revision raised the physician work value for 95903 by 0.3 RVUs (to 0.81 RVUs), raising the total RVUs for the procedure to 1.45, or about $52. With modifier -26 (Professional component) appended, payment falls to about $32 per unit of 95903 reported.

The changes became effective April 1, 2002, and are retroactive to Jan. 1, 2002, when CMS adopted the November 2001 fee schedule. Therefore, you may receive retroactive payment for any 95903 claims improperly reimbursed between Jan. 1 and April 1, 2002.

The retroactive reimbursement is not automatic, however. The CMS program memorandum specifically states, "Carriers and/or intermediaries need not search their files either to retract payment for claims already paid or to retroactively pay claims. However, carriers should adjust claims brought to their attention." In other words, you won't get the payment unless you ask for it, and that means refiling the claim. Although the change in reimbursement is minor, it could add up to hundreds of dollars if several dozen claims or more are involved.

If your Medicare payer is uninformed, confused or otherwise unwilling to provide retroactive payments for such claims, submit a letter with the claim and reference the Federal Register (Vol. 67, No. 81: Friday, April 26, 2002, under the heading "Rules and Regulations") along with a photocopy of the relevant information. The Federal Register clearly states that the original fee schedule information was a "technical error" and that the corrections announced in transmittal AB-02-18 "are effective as if they had been included in the document [i.e., the fee schedule] published November 1, 2001."