Neurology & Pain Management Coding Alert

Although nerve conduction studies (NCS) are among the procedures most commonly reported by neurology practices, confusion remains over how to code properly for them. Insurers often misunderstand the terminology of the associated CPT codes or fail to acknowledge that multiple nerves may require testing and that each test should be reimbursed independently. In addition, neurologists and neurology coders must observe documentation and frequency guidelines or risk forfeiting payment for services rendered. Know the Types of NCS CPT contains three codes to describe NCS types (motor, sensory and mixed):

95900 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study

95903 motor, with F-wave study 95904 sensory. 1. Motor NCS (95900 and 95903) involves stimulation at various points along a motor nerve containing motor fibers only. The response is recorded from a muscle innervated by those fibers.

Code 95903 is distinguished from 95900 by the recording of F-waves. The set up for an F-wave study (95903) is similar to that of a regular nerve conduction study (95900), but testing is conducted separately using different machine settings and separate stimulation to obtain more responses (generally, at least 10). Two coding examples illustrate the difference between these codes: Stimulation electrodes are placed on the radial motor nerve, and recording electrodes are placed on the extensor indicis proprius. Bill one unit of 95900. Stimulation electrodes are placed on the ulnar nerve, and recording electrodes are placed on the first dorsal interosseous, with F-waves. Report one unit of 95903. 2. Sensory NCS (95904) involves stimulation of sensoryfibers only, with recording on a different site along the same nerve, or stimulation of a nerve containing motor and sensory fibers while recording over apurely sensory branch of the same nerve. An example is stimulation at medium sensory nerve, recorded at the first and second digits. Code one unit of 95904. 3. Mixed NCS (95904) involves the stimulation of a nerve containing both motor and sensory fibers (a mixed nerve) and recording from a different location (also containing both motor and sensory nerve fibers) along the same nerve. CPT 2002 eliminated the term "or mixed" from the descriptor of 95904 to avoid the mistaken conclusion among some insurers and coders that 95904 was used to bundle motor and sensory studies (i.e., instead of reimbursing for one motor study [95900/95903] and one sensory study [95904], the insurer paid for a single "mixed" study [95904]). A true mixed NCS, however, is separate and distinct from either sensory or motor studies and should be reimbursed accordingly. An example shows how to code for a mixed nerve: Stimulate median mixed nerve (in palm, containing sensory and motor fibers) to lumbrical muscles, record at wrist. Report one unit of [...]