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Medicare Compliance & Reimbursement

Reader Question:

Counting Nerve Conduction Test Per Limb Will Result in Denials

Published on Fri Jul 23, 2010

Question: I coded my physician's diagnostic testing recently that included nerve conduction studies, an EMG, plus H-reflex testing. The doctor's final diagnosis was S1 radiculopathy (723.4). I billed all of the appropriate codes, plus an E/M code with modifier 25 in the following sequence: • 99213"25 • 95903"LT x 2 • 95903"RT x 2 • 95904"LT • 95904"RT • 95934"LT • 95934"RT • 95861. The patient's MAC denied a lot of the diagnostic studies. Why didn't we get paid for the full services provided? Answer: When your physician performs a nerve conduction study (NCS) and you code 95903 (Nerve conduction, amplitude and latency/ velocity study, each nerve; motor, with F-wave study) or 95904 (... sensory) test, you need to code per nerve or nerve branch, not per unilateral limb. Even though your doctor may have tested identically named nerves on both lower extremities, you don't need to indicate LT (Left [...]
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