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 [...]