Eli's Rehab Report

Question: We are often denied when we bill nerve conduction studies (95900-95904) with E/M codes. We have never had this problem before, but now I'm wondering if we have to use modifier -25 to bill these together.

Florida Subscriber

Answer: CMS requires modifier -25 if the physiatrist performs an evaluation on the same day as a nerve conduction study (NCS). Medicare policymakers know that most physicians perform a short history, assessment and muscle examination prior to the NCS to isolate the problem area, and Medicare includes this brief assessment as part of the NCS code. If your physiatrist performs a significant, separately identifiable evaluation on the same day as the NCS, bill both the NCS code and the E/M code with modifier -25 appended, but be sure to save the chart notes that demonstrate medical necessity for both services.

You Be the Coder and Reader Questions were reviewed by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J.