Neurology & Pain Management Coding Alert

Counting the number of separately billable nerve conduction studies (NCS) by determining which electrodes (stimulating or recording) are moved can prove frustrating, especially because many payers still do not understand the rules for designating multiple and separately reportable studies during the same session. However, the AMA has developed an alternative (and simpler) method to determine the correct number of nerve conduction studies for 2002. A Better Way Until now, determining the proper number of NCS meant tracking the movement of electrodes during the study, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J. If either the recording or stimulating electrode remained stationary during the study, only one unit of any NCS code could be reported. If both the recording and stimulating electrodes were moved if even to a different location on the same nerve multiple NCS units could be claimed. Note: For complete information on reporting NCS using this method, see page 33 of the May 2002 Neurology Coding Alert. But many coders and payers not to mention auditors and others who must review claims but who may not understand the exact mechanics of NCS find the above method confusing, says 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. In addition, a lack of understanding has lead many payers to deny claims for multiple units of NCS as a duplication of services, even if the tests were conducted on completely separate nerves, or to bundle incorrectly separately reportable motor (95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study and 95903, with F-wave study) and sensory (95904, sensory) studies into a single "mixed" (95904) study.

As an alternative to counting the number of "moving electrodes," the AMA developed a list of all the nerve conduction studies that can be coded as separate procedures. A preliminary version of the list was originally published in Principles of CPT Coding, Second Edition (pages 374 and 375), and a final version of the list has just been officially released in CPT Assistant. "I believe this will make the previous method obsolete," Busis notes. "Determining the correct number of separately billable studies should now be as simple as consulting a list." By comparing the physician's documentation against the list of separately reportable procedures, coders can easily identify the correct type and number of NCS codes to bill the studies conducted. Consult the List The AMA has arranged the list of separately reportable studies by type (motor or sensory/mixed) and location [...]