Orthopedic Coding Alert

Question: What should I count for nerves? If my orthopedist did a median transcarpal study and an ulnar transcarpal study and documented results for the "right median motor nerve," "left median motor nerve," "right ulnar motor nerve," and "left ulnar nerve," does this qualify for four or two units? For instance, should I report three units for 95904?

Texas Subscriber

Answer: All of these nerve studies are of the wrist and usually contain sensory responses. Therefore, you should only report 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory) x 4 units. Anatomically, we have a median nerve on the right upper extremity and also a separate and distinct median nerve on the left upper extremity. You should report an NCS on the two separate and distinct nerves with two service units. This means you would report motor NCS of the right median nerve, the left median nerve, the right ulnar nerve and the left ulnar nerve with 95903 x 4.

CPT states that you should report 95904 only once when the physician stimulates or records multiple sites on the same nerve. If the physician performs nerve conduction studies on two different branches of a given motor or sensory nerve, however, then you can report the appropriate code from the 95900-95904 series for each branch studied.

Caution: Before you submit this claim, you shouldn't report 95904 without actually seeing the diagnostic study or confirming with your physician that the nerve conduction study (NCS) tested the motor and sensory (mixed) nerve fibers.

Remember, 95904 identifies a specific nerve's ability to conduct electrical signals within the nervous system. Physicians perform this test on different parts of a specific nerve (i.e., different segments of a given nerve) to identify local pathological responses, if they exist.

Keep in mind: The term "transcarpal" literally means "across the wrist" and typically refers to sensory nerve conduction studies. If you are confused about the branches of sensory, motor, and mixed nerves, then flip to Appendix J in your CPT code book.