Neurology & Pain Management Coding Alert

Multiple nerve conduction studies are a common tool of neurologists, especially in diagnosing conditions such as carpal tunnel syndrome (354.0). Unfortunately, payers often misunderstand these tests and will reimburse only partially or may deny them altogether.

Tiffany Z. Eggers, JD, MPA, a policy analyst with the American Association of Electrodiagnostic Medicine (AAEM) in Rochester, MN, offers tips for correctly coding this procedure when using CPT codes 95900 (motor testing without F-wave), 95903 (motor testing with F-wave) and 95904 (<>tests of sensory response).

1. One nerve, one charge. When youre using 95900 (motor, without F-wave), you cant bill for different segments of the same nerve, says Eggers. Weve run into doctors who think they can do that.

2. Modifier -59 can help. Try using modifier -59 (distinct procedural service), Eggers advises, when coding 95900 with 95903 (motor, with F-wave) or 95904 (sensory). This modifier indicates a distinct procedure, so technically, you shouldnt have to do it. But often it helps to get it through.

3. Dont bill 95900 and 95903 together on the same nerve on the same day, warns Eggers. One is with an
F-wave study (95903) and one is without an F-wave study (95900), so obviously they couldnt be on the same nerve on the same day, she says.

On the other hand, you can use 95900 and 95903 for different nerves on the same day, since they then describe two distinct procedures provided on the same day.
Again, thats where modifier -59 can help.

Neurologists report they are frequently denied payment when they bill 95900 and 95903 for the same patient in the same visit. These codes have been subject to a Health Care Financing Administration (HCFA) edit that is designed to detect unbundling or splitting of CPT codes, such as reporting separate codes for related services that are supposed to be covered by one comprehensive code. The government is attempting to detect unbundling for 95900 and 95903 billed to the same nerve. However, 95900 and 95903 can be billed to the same patient on the same day when multiple nerves are tested, some with and some without F-wave studies.

4: Beware of modifier -51. Modifier -51 (multiple procedures) is not appropriate when reporting nerve conduction studies performed on multiple nerves (95900-95904). While some carriers have insisted that modifier -51 be appended to these procedure codes if multiple nerves were tested on the same day, this is incorrect coding. The American Medical Association (AMA) concurs with the AAEM on this issue.

Relative values for these codes were deliberately set low to reflect that these procedures are usually performed multiple times on a patient in a single examination. The physician work and supplies involved in multiple nerve conduction studies are multiples of those involved in a single nerve conduction study. There are no economies of scale involved in giving multiple tests to a patient in one setting. If your carrier erroneously tells you to append these codes with the lower-paying modifier -51, insist that this is incorrect coding and include documentation from the AMA on this issue.

5. Billing for nerve branches. The AAEM concedes that there is still confusion about how to bill for mixed nerve conduction studies and the circumstances that must be met before studies of the branches of the same nerve can be coded as two different studies.

Note: The American Academy of Neurology (AAN) and American Academy of Physical Medicine and Rehabilitation (AAPMR) have endorsed code changes proposed by the AAEM that would clear up this confusion. If accepted, they would become effective Jan. 1, 2000. NCA will keep you updated on this matter.

Branches of the same nerve can be considered separate for billing purposes. The key, says Eggers, is whether you have to move both electrodes. If you have to move both electrodes, then it can be billed again, she says.
6. Observe annual limits. In general, you are limited to no more than four nerve conduction studies for most indications each year. Some examples:

carpal tunnel syndrome (354.0), unilateral: three motor studies and four sensory

radiculitis (729.2): three motor and two sensory

mononeuritis (355.9): three of each

myopathy (359.9): two of each

polyneuropathy (357.x): four of each.

These limits dont apply if the patient requires evaluation for a second diagnosis the same year. There may be cases where additional testing is needed. If so, include documentation in the patients chart that shows the medical necessity for more tests. Payers expect that repeat testing wont be necessary in 80 percent of cases. Be sure to include comparisons with the previous test results in the documentation.