Neurology & Pain Management Coding Alert

Question: Using a dermatome-specific procedure, we evaluate eight to 10 nerves on the lower extremities and 12 nerves on the upper extremities. The insurer has asked that we code this by units, but CPT includes no such codes. How can we code to comply with the insurers requirements?

New Jersey Subscriber

 
Answer: Only one unit of 95925 (short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs) and/or 95926 (... in lower limbs) is ever billed. The insurer may be misinterpreting these codes, the descriptors for which specifically state any/all peripheral nerves and upper or lower limbs (plural). In addition, a note following the descriptors specifies, To report a unilateral study, use modifier -52 [reduced services]. Therefore, if only one upper or lower extremity is tested, a reduced service has been performed and modifier -52 must be appended.
 
By asking you to itemize the service, the carrier may be seeking to further reduce reimbursement based on the number of nerves tested. This is contrary to CPT guidelines, and you may wish to appeal this requirement with the insurers medical director.