Neurology & Pain Management Coding Alert

Question: Should we bill modifier 59 when our neurologist performs multiple levels of EMGs? For example, can we bill 95903 x 6, 95903 x 3 and then 95903-59 x 3?

Nevada Subscriber

Answer: Determine how you would answer this question before turning to page 7 for the answer.

Answer: The note below 95904 in CPT states, "Report 95900, 95903 and/or 95904 only once when multiple sites on the same nerve are stimulated or recorded." Based on that information, some coders recommend reporting the procedure code (such as 95903, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) with the total number of injections.

Example: If your neurologist studies three motor nerves on each hand, you will bill 95903 x 6.

Another perspective: Other coders do not group all the nerve studies together. Instead, they bill each study separately so the claim includes modifiers to indicate separate nerves.

Example: If you code the procedure this way, report 95903 with modifiers RT (Right side) or LT (Left side) or modifier 59 (Distinct procedural service) so the payer understands how many studies your physician completed.