Neurology & Pain Management Coding Alert

Question: Medicare denies claims for modifiers with 95903, 95904, and 95934. We're submitting modifier 26 on 95903/95904 and modifiers 50 and 26 on 95934. We only code for the physician portion of the service. Why are we getting denials?

Florida Subscriber

Answer: Each insurance company has its own guidelines for how you should submit claims for 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study), 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory), and 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle). Check with your local carrier regarding these possible preferences:

According to Medicare guidelines, you should report the most significant modifier first. In this case, that means listing modifier 26 (Professional component) before modifier 50 (Bilateral procedure).

The denial might be related to the quantity of units of service you reported instead of the modifier usage. Most Medicare contractors have limitations on the quantity of units of service for nerve conduction studies, so check your specific guidelines.

The place of service might trip up your claim. Most of the times when a physician bills only for the professional component, the diagnostic studies are performed in a facility site of service.

Verify that the ICD-9 code linked to the procedure supports medical necessity.

Non-Medicare note: Some commercial payers will deny claims with modifier 50. In that case, you should report bilateral procedures by including modifiers LT (Left side) and RT (Right side).

Another option: Call the department that billed the technical component of the service. Ask how they reported the service so your codes will correlate.