Neurology & Pain Management Coding Alert

Question: If our physician performed sensory nerve conduction studies (NCS) on both the ulnar nerve to the fifth digit and the dorsal ulnar cutaneous nerve, may I report two separate studies?

Massachusetts Subscriber

 

Answer: In this case, you may report two separate NCSs because the physician studied two separate nerves (the ulnar digital sensory nerve and the dorsal ulnar cutaneous sensory nerve), and the descriptor for sensory NCS code 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory) clearly specifies each nerve. Some payers may require you to use modifier -59 (Distinct procedural service) for the second and subsequent NCS units, but CPT guidelines do not require it and therefore you should ask for the payers instructions in writing.
 
If the physician tests several sites along the same nerve, you should report only a single unit of 95900-95904 (as appropriate). The AMA has published a list of all nerves that qualify as separate studies, which can serve as an easy reference when attempting to determine the number of units to report (see Neurology Coding Alert June 2002, Use New AMA Nerve List to Determine Billable NCS Units).