Neurology & Pain Management Coding Alert

If you have submitted a recent claim for 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) and 95904 (nerve conduction, amplitude and latency/velocity study, each nerve; sensory or mixed) or 95903 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) and 95904 on the same date of service, you may receive a denial. A Correct Coding Initiative (CCI) edit issued in June began bundling the codes into 95904. The Health Care Financing Administration (HCFA) has since announced that it will delete the edit. If your claim was denied you can resubmit it with modifier -59 (distinct procedural service).

Tiffany Z. Eggers, JD, MPA, policy director/legislative counsel for the American Association of Electrodiagnostic Medicine (AAEM), reports that on June 5, HCFA instituted a CCI edit bundling codes 95900 and 95903 into 95904. This edit has caused many of neurology claims to be denied by Medicare and third-party payers who follow CCI edits. It also has prompted a wave of protests from neurologists.

CCI Edit to Be Deleted

HCFA informed the AAEM in a July 7 letter from Niles R. Rosen, MD, CCI medical director, that this edit will be deleted in the carriers claims processing through CCIs Version 6.2 Update, which is scheduled for an Aug. 14 implementation date. Prior to Aug. 14, providers can submit claims attaching the -59 modifier to either code of each code pair edit. Neurologists who have had claims denied can either resubmit with the -59 modifier or wait until after Aug. 14 and resubmit without the modifier.

Until Aug. 14, the AAEM recommends that neurologists receiving denials when billing 95900 and 95904 or 95903 and 95904 on the same date of service write a letter to their local Medicare carrier alerting the carrier that this was an erroneous CCI edit that is soon to be rectified. The following statement also may be attached to explain the difference between the nerve studies in question. If problems continue with the local Medicare carrier after Aug. 14, the neurologist may need to send another letter to the carrier director to remind them of the change.

Explanatory Statement: Mixed Nerve Conduction Studies, CPT Code 95904

The following statement was prepared by the AAEM and has been offered with their approval. It also may be found on their Web site: http://www.aaem.net:

Physicians Current Procedural Terminology (CPT) 2000 includes a change in the descriptor for CPT code 95904, which now reads, Nerve conduction, amplitude and latency/velocity study, each nerve; sensory or mixed. Previously, CPT code 95904 had been used exclusively for billing sensory nerve conduction studies (NCS). In CPT 2000, the descriptor for this code was expanded, and it can now also be used for billing associated with mixed NCSs. Although mixed NCSs are used in numerous clinical situations, there has always been confusion regarding the appropriate CPT code to use for this type of study. The revision of the descriptor for CPT code 95904 was intended to clear up this confusion.

Unfortunately, some insurance companies and third- party payers are unaware of what constitutes a mixed NCS and assume CPT code 95904 can now be used to bundle motor and sensory NCSs. As a result, rather than providing reimbursement for each separate motor and sensory NCS, as would be appropriate, some companies are providing reimbursement for only one study per nerve. The purpose of this statement is to document that mixed NCSs are separate and distinct from both sensory NCSs and motor NCSs.

A sensory NCS involves stimulation of a nerve at a site where it contains only sensory fibers and recording the response from a different site along that nerve, or stimulation of a nerve containing motor and sensory fibers and recording over a purely sensory branch of that nerve. An example of a sensory NCS would be stimulating the median nerve at the wrist or mid-palm and recording the response over median nerve sensory nerve fibers in one of the first three fingers or the thumb. Sensory NCSs are billed using CPT code 95904.

A motor NCS involves stimulation at various points along the course of a motor nerve containing motor fibers and recording the electrical response from a muscle innervated by those fibers. An example of a motor NCS would be stimulating the median nerve at the wrist or mid-palm and recording the response over the abductor pollicis brevis (APB) muscle. Motor NCSs are billed using CPT code 95900 and/or 95903.

A mixed NCS involves stimulation of a nerve containing both motor and sensory fibers (a mixed nerve) and recording from a different location along that nerve that also contains both motor and sensory nerve fibers. The resulting record is a mixed nerve action potential that represents activity in both motor and sensory nerve fibers. An example of a mixed NCS would be stimulating the median nerve at the mid-palm region and recording from the median nerve at the wrist. The median nerve in these locations contains motor fibers going to small muscles in the hand and sensory fibers innervating the skin of the palm and fingers; therefore it is a mixed nerve. Mixed NCSs are billed using CPT code 95904.

Study of the sensory, motor, and mixed nerve fibers of a given nerve constitutes three separate and distinct services and should be billed and reimbursed accordingly. For example, if median motor (without F-wave study), sensory, and mixed nerve fibers are all evaluated in a single limb, reimbursement should be provided for all three studies, as described below.

Two units of CPT code 95904
(one for the sensory nerve conduction study and one for the mixed nerve conduction study)
One unit of CPT code 95900
(one for the motor nerve conduction study, without F-wave).