Neurology & Pain Management Coding Alert

Question: I’d like to have your input on coding a nerve conduction study. The neurologist documented the following: 

Motor:

• R Median to APB (wrist, elbow)
• R Median to 2^nd Lumbrical
• R Ulnar to 1^st DI
• L Median to APB (wrist, elbow)
• L Median to 2^nd Lumbrical
• L Ulnar to 1^st DI
• L Ulnar to ADM (wrist, below elbow, above elbow)

Sensory:

• R Sural (midcalf)
• R Superficial peroneal, medial dorsal cutaneous branch
• R Median to 2^nd digit
• R Median to 4^th digit
• L Median to 2^nd digit
• L Median 4^th digit
• L Ulnar to 5^th digit.

She billed 95911 for 9-10 studies. Shouldn’t this be billed as 95912 for 11-12 studies? The physician is not counting digit IV in Median R and L because she said the recording is in the same place. I think it can be counted.

Nevada Subscriber

Answer: When counting the nerves mentioned, you find a total of approximately 14 examined (both motor and sensory), except Median R and L (Digit V), which is not the correct branch of the median nerve. Based on this count, your correct code is 95913 (Nerve conduction studies; 13 or more studies).

Tip: Remember that Appendix J in the CPT^® codebook identifies the median sensory to the fourth digit as a separate sensory nerve branch from the median sensory to the second digit, which is why you count these as two separate NCS.