Neurology & Pain Management Coding Alert

Question: We conduct multiple sensory and/or motor nerve conduction studies for patients, but some of our carriers only pay for four units per code, regardless of how many nerves the physician tests. What should we do in these cases?

Kansas Subscriber

Answer: When patients complain of bilateral extremity pain, numbness or tingling, physicians often need to test multiple different nerves to reach a final diagnosis. Some carriers predetermine limits for nerve conduction studies in their claims processing software, but you can usually submit documentation and reverse the denial.

What to do: You need to code each nerve test individually and include documentation that shows your physician's findings for each test. Some examples of this are as follows:

- right median sensory nerve, 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory)

- left median sensory nerve, 95904

- right ulnar sensory nerve, 95904

- left ulnar sensory nerve, 95904

- right radial sensory nerve, 95904

- left radial sensory nerve, 95904.

Extra credit: Include a copy of Appendix J from CPT, which states that nerves are separate and distinct from one another. Ask your physician to dictate the medical necessity for surpassing the standards if he exceeds the number of studies outlined in the Appendix J table.

For example: Your physician might document, "It was necessary to test each digit in the left hand because the patient suffered an injury to that hand. This will assist in the determination of the extent of the injury and potential need for surgical treatment."