Neurology & Pain Management Coding Alert

Answer: QST measures function in both large- and small-caliber fibers, whereas motor and sensory nerve conduction velocity tests (95900-95904) measure only large-caliber fibers. The common physical stimuli used during testing are touch-pressure, vibration and temperature (hot/cold). QST is a psychophysical measure requiring an alert, cooperative patient.

CPT does not contain a specific code for QST. Medicare guidelines specify that the value of QST in patient management is "unclear," and Medicare (and many third-party) payers do not routinely reimburse for the procedure, arguing that the diagnostic value of the test "has not been established" and "there are no prospective clinical studies demonstrating that quantitative tests of sensation improve the management and clinical outcomes of patients over standard qualitative methods of sensory testing."

CMS regulations further specify, "In unusual circumstances, when the clinician feels that this test is essential for proper diagnosis and treatment, the claims should be accompanied by appropriate documentation. These claims should be submitted with miscellaneous code 95999 [Unlisted neurological or neuromuscular diagnostic procedure] for a claim-by-claim analysis and review. The description of the service should be listed in Item 19 of the CMS-1500 Claim Form." Medicare specifically forbids use of nerve conduction and sensory evaluation codes 95900-95904 and 95921-95937 to report QST (including current perception threshold testing).

In most cases, non-Medicare insurers will follow similar guidelines, although you should contact the payer prior to billing to learn its policy.