Neurology & Pain Management Coding Alert

Question: My neurologist performed a sensory nerve conduction study on the right median sensory nerve to the patient's first digit and also right median sensory nerve to the patient's third digit. Can I separately report this study as two units of 95904? Or is this considered testing of multiple sites on the same nerve and only one sensory nerve conduction study?

Texas Subscriber

Answer: Since the median sensory nerve to the first digit (I.D.1) and median sensory nerve to the third digit (I.D.3) are listed separately, you can report 95904 (Nerve conduction, amplitude and latency/ velocity study, each nerve; sensory) with two units of service. This indicates that your neurologist performed two separate and distinct diagnostic sensory nerve conduction studies (NCS).

Reminder: Take note that if your neurologist was performing an NCS on multiple sites but on the same nerve, you would only be able to report 95904 once. Likewise, if your neurologist tests the right ulnar sensory nerve to the fifth digit (I.G.3) at the wrist, below the elbow and above the elbow, you would only report one unit of service of 95904.

In this case, you are correct in recognizing the need to code each nerve test individually and include documentation that shows your neurologist's findings for each test. Some payers predetermine limits, such as a limit of three units of service, for sensory nerve conduction studies in their claims processing software. You can usually submit documentation to appeal a denial, however.

Helpful hint: Appendix J (Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves) of the CPT manual lists the individual branches of sensory, motor, and mixed nerves and indicates that each nerve listed constitutes one unit of service. This table also provides information regarding the reasonable maximum number of studies performed per diagnostic category necessary for a physician to arrive at a diagnosis in 90 percent of patients with that final diagnosis.

Reinforcements: Ask your neurologist to dictate the medical necessity for surpassing the standards if he exceeds the number of studies outlined in Appendix J. For example, the reasonable maximum number of sensory nerve conduction studies to reach a final diagnosis of unilateral carpal tunnel syndrome is four. A neurologist's documentation should clearly support the medical necessity for additional sensory nerve testing beyond the four indicated in the table.