Neurology & Pain Management Coding Alert

Question: We've recently begun performing a test n our office that our neurologists are calling a "long exercise test." It's basically a repetitive stimulation test with multiple stimulations, and it takes over an hour to complete. I know that when we bill for it, we can only use the code once per nerve, but is there any way we can account for the extra time these tests take?

California Subscriber

Answer: The test you're referring to does sound like a neuromuscular junction (NMJ) test, for which you would use 95937 (Neuromuscular junction testing [repetitive stimulation, paired stimuli], each nerve, any one method).

If your provider needed to spend a substantial amount of additional time performing the NMJ testing than typically required, you can look to append modifier 22 (Increased procedural service) to 95937. Your neurologist's documentation must support the substantial additional work and the reason for the additional work, such as increased intensity, time, technical difficulty of procedure, severity of patient's condition, or physical and mental effort required.

Neurologists will most often use NMJ as a diagnostic test for myasthenia gravis (358.0x). This test consists of recording muscle responses to a series of nerve stimuli (at variable rates), both before, and at various  intervals after, exercise or transmission of high-frequency stimuli.

For your neurologist to perform the test properly, it will often require him to test two separate nerves. You could then report two units of service. If he tests a single nerve before and after exercise, however, you should report one unit of service per each nerve tested, not the number of times the nerve was tested or the number of stimulations per nerve.