Neurology & Pain Management Coding Alert

Question: My neurologist performed a nerve conduction study (NCS) without F-waves on the ulnar nerve. Then realizing he needed more data, he performed another NCS on the same nerve but with F-waves on the following day. Can we report both codes?

Tennessee Subscriber

Answer: You should report the NCS without F-waves on the ulnar nerve (95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) and a separate unit of the NCS with F-waves (95903, ... motor, with F-wave study). Make sure your neurologist's documentation supports the separate units because your claim will most likely raise a red flag with your payer.
 
Snag: The National Correct Coding Initiative bundles 95900 to 95903 for tests on the same nerve.
 
Therefore, in this case the coder should have reported only the more extensive procedure (95903). You should always keep an updated version of the NCCI handy and constantly refer to it.
 
Remember: Anytime you report multiple CPT codes on a claim form, you must consider that one or more of the services you are reporting could be an included component of another more extensive procedure that you-ve also claimed.
 
Reporting an included service separately is called -unbundling,- and it's one of the most common problems with Medicare claims, according to CMS.
 
Bonus: You can access the NCCI edits without cost at the CMS Web site www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.
 
From there, you can also access the NCCI overview page, which includes links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.

 -- 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, CPC-EMS, RCC, coding analyst for CodeRyte Inc. and founder of the Coding & Reimbursement Network (www.crn-web.com).