Neurology & Pain Management Coding Alert

Question: What is the correct way to report a bilateral H-reflex study of the gastrocnemius muscles?

California Subscriber

Answer: Physicians often perform H-reflex studies of the gastrocnemius muscles on both lower extremities. Code the procedure with 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle). If your neurologist conducts an H-reflex study on other muscles, report 95936 (- record muscle other than gastrocnemius/soleus muscle).

CPT notes direct you to append modifier 50 (Bilateral procedure) for a bilateral study. Some carriers, however, prefer that you report bilateral services with modifiers RT (Right side) and LT (Left side). Check your carrier guidelines to verify whether you should submit 95934-50 with one unit of service or 95934-RT with one unit of service plus 95934-LT with one unit of service.

Heads-up: Some payers- claims processing software struggles with claims reporting 95934 with two units of service. The system might process the procedure as one unit or might deny the claim. Again, discuss the procedure with your carrier to ensure you submit the correct documentation for appropriate reimbursement.