Neurology & Pain Management Coding Alert

Question: Are autonomic testing codes (95921, 95922 and 95923) mutually exclusive? I've been having trouble reporting more than one of these codes for the same patient on the same date.

Vermont Subscriber Answer: Yes, you should be able to report autonomic testing codes 95921 (Testing of autonomic nervous system function; cardiovagal innervation [parasympathetic function], including two or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio), 95922 (... vasomotor adrenergic innervation [sympathetic adrenergic function], including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least five minutes of passive tilt) and 95923 (... sudomotor, including one or more of the following: quantitative sudomotor axon reflex test [QSART], silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential) separately on the same date of service.
 
Prior to Nov. 1, 2001, the National Correct Coding Initiative did bundle 95921, 95922 and 95923. Since then, however, CMS has acknowledged that 95921, 95922 and 95923 describe different services and that there are circumstances in which the neurologist may have a medically necessary reason to report two or more autonomic testing codes on the same day. If your payer bundles these codes, you should appeal the decision.
 
But several payers - including some Medicare carriers - consider these tests to be investigational and may not reimburse for 95921, 95922 and 95923. Ask your individual payer for its policy.  - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.