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 [...]