Neurology & Pain Management Coding Alert

Question: We billed 95900 and 95903 for a motor nerve conduction study and an F-wave study of the right median nerve. Medicare denied the claim. Should I refile the claim with a modifier?

Illinois Subscriber

Answer: Because the neurologist performed the motor NCS and F-wave study on only a single nerve -- the right median nerve, you should bill only 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study). CPT specifies that 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), 95903, and 95904 (Nerve conduction ... sensory) should be reported only once even if multiple sites are stimulated or recorded as long as they are on the same nerve. Reporting both CPT codes and appending a modifier to bypass theCorrect Coding Initiative (CCI) edit would be noncompliant coding.

Medicare's CCI edits bundle 95900 as a column 2 code or component of 95903, the more comprehensive column 1 code. Code 95903's descriptor indicates that95903 includes the motor nerve conduction study (NCS) and the late response, F-wave study. CMS allows a modifier to bypass this bundle if the studies are performed on separate and distinct different nerves.

Using modifier 59 (Distinct procedural service) for 95900 and 95903 is still appropriate when billing for nerve conduction studies done on truly distinct nerves -- for example, motor NCS on the right ulnar nerve to the abductor digiti minimi muscle and motor NCS with F-wave on the right median nerve to the abductor pollicis brevis muscle. Use Appendix J -- Electro-diagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves of the CPT manual to help you check which nerves are truly distinct.