Neurology & Pain Management Coding Alert

Question: When I-m coding for nerve conduction studies, do payers consider amplitude and latency/velocity study with the F-wave study and without the F-wave study to be unbundled? What I want to know is whether I can bill these together if they are performed on the same nerve.

Alaska Subscriber

Answer: Your best course of action is to bill only for 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study). When this procedure is performed on the same nerve, 95903 encompasses the elements of procedure 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study).

As CPT 2008 says, you can "report 95900, 95903 and/or 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory) only once when multiple sites on the same nerve are stimulated or recorded."

What not to do: Medicare will send you a denial if you bill for these procedures separately with modifier 59 (Distinct procedural service) -- if the neurologist performs both procedures on the same nerve.

However: If the neurologist does not perform both procedures on the same nerve, you should code using 95900 with modifier 59.

For example: If the motor nerve was the only one the neurologist tested on the median nerve -- but he tested both the motor and F-wave on the ulnar nerve -- you should code using 95900 with modifier 59 for the median testing and 95903 for the ulnar nerve testing.

-- 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.