Neurology & Pain Management Coding Alert

Question: May we bill for nerve conduction studies (NCS) when a nonphysician staff member performs the service in an office setting without the physician present?

Illinois Subscriber

Answer: In limited cases, you can bill for NCS without the physician present, but the billing party must meet scope-of-practice and certification requirements.
 
A registered nurse or nonphysician practitioner may perform both the technical and professional components of nerve conduction studies (95900-95904), but only under the direct supervision of a physician, according to CMS. "Direct supervision in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure," the memo states. However, the physician does not need to be present in the room when the procedure takes place.
 
A technician under the general supervision of a physician may provide the technical component of a nerve conduction study, but the physician must provide the professional component. General supervision "means the procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure," the CMS memo says. The physician is responsible on an ongoing basis for the training of those persons performing the diagnostic procedure, as well as for the maintenance of the equipment and supplies necessary to conduct the tests.
 
Physical therapists (PT) with American Board of Physical Therapy Specialties (ABPTS) certification can perform NCS without physician supervision. An ABPTS physical therapist may also personally supervise another PT providing NCS, but only the certified PT may bill for the service. Personal supervision means the physician or the certified physical therapist must be in the room when the procedure is performed.
 
Note: For more information on physician supervision requirements, visit the American Association of Electrodiagnostic Medicine (AAEM)  Web site at www.aaem.net.