Neurology & Pain Management Coding Alert

Don’t miss reporting biopsies, injections, and arthrocentesis.

You can report nerve conduction with other procedures -- just make sure you identify these as distinct services in order to report them together, according to the most recent Correct Coding Initiative (CCI) edits version 19.0.

Background: "Nerve conduction studies are ordered to evaluate the functional status of nerves, most commonly to fully diagnose carpal tunnel syndrome, or other peripheral nerve injuries, such as cubital tunnel syndrome or tarsal tunnel syndrome," says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C. "They are used to evaluate possible cervical or lumbar radiculopathies. They may also be used in the cases of documented nerve injuries to evaluate the status, or lack thereof, of nerve recovery, and can be used to help make the diagnosis of more systemic nerve disorders."

Append a Modifier to 95907-95913

Codes 95907 (Nerve conduction studies; 1-2 studies) — 95913 (Nerve conduction studies; 13 or more studies) are column 2 codes for some other procedure codes, but a modifier is allowed in order to differentiate between the services provided. You append modifier 59 (Distinct procedural service) to 95907-95913 when reporting these codes together.

Highlights of the CCI edits related to nerve conduction studies include:

You can report nerve conduction with muscle biopsy codes 20205 (Biopsy, muscle; deep) and 20206 (Biopsy, muscle, percutaneous needle), as well as vertebral body biopsy code 20250 (Biopsy, vertebral body, open; thoracic).

You can also report 95907-95913 with the injection procedures like injection in the fascial cord, 20527 (Injection, enzyme [eg, collagenase], palmar fascial cord [ie, Dupuytren’s contracture]) and that into the tendon sheath or ligament, 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [eg, plantar "fascia"]).

Bypass the Bundling Edits For NCS

When your neurologist performs a nerve conduction study with arthrocentesis, you can claim both procedures. Report codes 20600 (Arthrocentesis, aspiration and/or injection; small joint or bursa [eg, fingers, toes]), 20605 (… intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]), and 20610 (… major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) with 95907-95913. Append modifier 59 to the code you report from 95907-95913. An example of this situation is when your neurologist does nerve conduction studies of right upper extremity for possible carpal tunnel syndrome and also gives an intra-articular knee injection for pain. "It would be appropriate to use a modifier to bypass the NCCI bundling edits as the NCS were performed on a different anatomic area and was not performed as part of the intra-articular joint injection," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO.

Know What Is Inclusive In NCS

There are some codes that are comprehensive to the new NCS codes. You cannot bypass the bundling edit with a modifier when you report these codes with the new NCS codes. In other words, you cannot bill them together in any circumstance. Here’s the lowdown:

Codes for injection of diagnostic or therapeutic substance(s): 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) - 62319 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]).

Codes for drug infusion pumps: 62367 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; without reprogramming or refill) - 62370 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill [requiring skill of a physician or other qualified health care professional])

"The new NCS codes cannot be billed with these when performed on the same beneficiary, same date of service and same provider," says Hammer.

Editor’s note: Additional information about CCI edits is available at http://www.cms.hhs.gov/NationalCorrectCodInitEd.