Wiki 2013 NCV Coding Changes

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rrmrecine

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I'm a confused on the addition of the new codes for NCVs. Previously, we were billing 1 unit per nerve tested and now its per study. Can anyone clarify the new changes??
 
Previously we counted "units" by the number of different nerves tested. For example, a sensory test of the ulnar nerve and medial nerve, even if performed on multiple places along the same nerve, was coded as 95904 x 2 units. You still count the different tests the same, but instead of putting multiple units on the code for that specific test, you count the total number of tests done, and select the code based on that number. In above example, this is 2 studies (1 ulnar sensory test, 1 medial sensory test), which goes with code 95907 (1-2 studies).

If you look at Appendix J in the CPT book, any study that is listed can be counted as a separate study.

Hope this helps!
 
Also hopefully this might help with code selection. From the guidelines: "For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with or without F wave test, or an H-reflex test." Based on that, as mhstrauss said anything that's in Appendix J would be counted once each. F-waves would not be billed separately however. You add up all the nerves tested and pick a code. Hope that helps! :)
 
We are having a terrible time with these new codes. I do not think it's us though. It's Palmetto GBA. I think thier edits are wrong. Say we bill 95907 with 95886. They deny the claim stating that a qualifying service for 95886 is missing ie 95904 (a deleted code).
They will not budge. That's what the edit says and they are sticking to it.
Am I wrong?
 
no you are not wrong it is happening everywhere. The only thing I know to do is to appeal with a copy of the page out of the CPT book showing the codes deleted and added.
 
I suspected as much Deb. The confirmation is nice though so thanks.
I think I will suggest that they hold the claims until the edits are corrected.
Fun Fun!!!
 
Branches of nerves?

What do you do with the text in the CPT book that states "Each type of nerve condition study is counted only once when multiple sites on the same nerve are stimulated or recorded."

To me, it sounds like each nerve can only be counted once per study - even if they study a branch of the nerve.
Any feedback?

:eek:
 
Confirmation on counting branches

A question about the branches, though, just to confirm: If we have, say, median sensory to 1st digit and also medial sensory to 4th digit, this would count as two studies?

I get the bit about not counting multiple sites on the same nerve, but the research I did on branches seems contradictory--some reliable sources saying "yes, count branches" and still other equally reliable sources saying "no, one study per nerve, period".

Given that electrodiagnostic studies are on the OIG work plan this year, we sure don't want to overcount. But with the payment reduction, we sure don't want to undercount, either.

Any advice is much appreciated!:)
 
Yes The information in Appendix J regarding what constitutes a separate nerve study remains the same, e.g.
Median motor nerve to APB and Median motor nerve to first lumbrical are counted as two studies​
likewise with sensory nerves:
Median sensory to 1st digit and Median sensory to the 2nd digit are also counted as 2 studies​

If the physician performed these nerve conduction studies, a total of 4, the diagnostic tests would be coded with 95908 with 1 unit of service
 
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