Neurology & Pain Management Coding Alert

Question: My neurologist performed 95860, 95900, and 95904 on a patient. Shouldnt I append modifier 59 (Distinct procedural service) to these to make clear they were separate procedures?

Texas Subscriber

Answer: There are no National Correct Coding Initiative (NCCI) bundling edits between codes 95860 (Needle electromyography; one extremity with or without related paraspinal areas), 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), and 95904 (... sensory). It is not necessary to append modifier 59 to any of these three codes. The code descriptions for each of these diagnostic services clearly identify them as separate, distinct, and different tests.

On a side note: The motor nerve conduction study without F-wave code (95900) is bundled as a component of the comprehensive motor nerve conduction study with Fwave code (95903). If your physician performed both motor NCS services on different or separate nerves or nerve branches then you would need to append modifier 59 to 95900 to tell that payer that the diagnostic study was performed on a separate or distinct nerve or nerve branch.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.