Wiki Need some experienced advice for nerve conduction studies

[ollielooya]

Not sure why I'm posting on the forum on a Friday night, but perchance there may be someone who can help. First of all I'm new to this type of coding and billing and my concerns regard the proper use of modifiers for the 95903, 95904 when billed with 95861 and 95886. WHAT specificially in the medical record determines when modifier 59 MAY be appropriate to add to 95903 and 95904? What should I be looking for? MCR only paid on the 95861. Here's excerpt from the report:

Nerve Conduction Study and Electromyography/Bilateral Lower extremity Nerve Conduction Study and EMG report.Indication: pain, numbness tingling in his lower extremities. Noted no hx of diabetes or other pertinent hx.

NCS: A Caldwell Sierrawave machine was used to study bilateral tibial, peroneal, and sural nerves, F wave studies. Data and waveforms attached.

Right Lower Extremity: Tibial motor study today-normal distal latency, normal NCV, decreased amplitude thruout. No response F wave study. Pewroneal motor study-normal distal latency, normal ncv, decreased amplitude at popliteal fossa and fibula stimulation points. No response F wave study Peroneal sensory study-prolonged sital latency. Sural sensory study - no response

Left Lower Extremity
Tibla motor study-normal distal latency, normal NCV, decreased amplitude at knee stimulation point. No response F wave study. Peroneal motor study-normal distal latency, decreased amplitude at all stimulation points, normal NCV, No response F wave study. Peroneal sensory study-no response. Sural sensory study-no response

EMG
A disposable, monopolar EMG needle was used to examine select muscles in the right and left lower extremities. In creased spontaneous activity left tibialis anterior muscle. Rest of his L and R leg needle exam is normal.

Impression: -------------

Thanks to any and all who respond and if none do over the weekend may resubmit.

 

[Sladjana.V]

Hi Suzzane,

When NCS and needle EMG is performed on the same day, you should either use cpt 95885 or 95886 per extremity in addition to your codes for motor, f-wave and sensory nerve study. The choice will depend on number of muscles tested per extremity. If only 4 muscles were tested you will report 95885 X number of extremity tested. If 5 or more muscles were tested you will report cpt 95886 X number of extremity. In your example I could not tell how many muscles were tested per extremity. You might want to check with your physician, but the coding should look something like this:

95903 X 4 (tibial and preoneal nerves-2 for each extremity) motor and F-wave
95904 X 4 ( peroneal and sural sendory nerve- 2 for each extremity
95885 X 2 or 95886 X 2 depends on the # of muscles tested per extremity. Please check with your physician because the report did not give the complete listed of all muscle tested.

In your case, you should not code 95861 because needle EMG was done on the same day.
I hope this helps.

 

[ollielooya]

This is excellent advice and I will follow up accordingly. I hope you'll revisit this thread because it may be that I'll need some followup and hope you will be here to answer. Not sure how many others may offer their opinions, but this is a great start. Thank you so much!

 

[aaron.lucas]

Hi, Sladjana was correct in her coding, and also in saying that 95861 should not be used along with NCV. That is actually included in the EMG guidelines in the 2012 book if you need to refresh at any point. I would also like to add that 59 should not be needed on 95903 and 95904. The only time you would need modifier 59 is if you billed 95900 and 95903 together, because 95900 is included in 95903 when they are performed on the same nerve. This is also an NCCI edit, with modifier allowed. You would use 59 on 95900 to show that it was done on a different nerve from 95903. Does that make sense? Hope I could help!