Neurology & Pain Management Coding Alert

If you confuse monofilament testing with sensory EPs, you'll lose more than $60 per claim Neurology coders faced with evoked potential (EP) claims can find themselves with questions that CPT doesn't address. Our experts provide the answers you need to end the guesswork and report your EP claims correctly. Question 1: Which Codes Describe EP? Answer 1: CPT contains six codes to describe EP studies. These include two auditory studies, three sensory studies, and one visual study:

CPT 92585 -- Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
92586 -- ... limited
95925 -- Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs
95926 -- ... in lower limbs
95927 -- ... in the trunk or head
95930 -- Visual evoked potential (VEP) testing central nervous system, checkerboard or flash. EP studies measure the brain's electrical activity in response to stimulation of specific nerve pathways, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. The neurologist uses this information to diagnose nerve disorders, multiple sclerosis and other conditions; to locate damaged nerves; or to evaluate a patient's condition during surgery or following treatment. Question 2: What Distinguishes a Comprehensive Audio Study? Answer 2: To report a comprehensive auditory evoked response (AER) exam (92585), the neurologist must measure middle latency and late cortical responses and evaluate brainstem response, says Debra Abel, AuD, owner of Alliance Audiology, in Alliance, Ohio. By combining these three types of auditory EPs, the physician can evaluate the status of several areas of the central auditory nervous system (for example, auditory periphery and brainstem, pathways between midbrain, etc.).

A limited audiometry examination (92586) describes limited auditory brainstem response (ABR) testing used primarily in infant screening evaluations. The physician obtains and replicates the AER screening at one or two levels for each ear only, rather than the three levels necessary to report 92585, Abel says. Question 3: How Should I Code Multiple Skin Sites?
 
Answer 3: Regardless of the number of skin sites (dermatomes) the neurologist tests during sensory EPs, you may report only a single unit of 95925-95927, as appropriate to the body area the neurologist studies, Busis says.

Example 1: The neurologist tests three skin sites each on the left and right arms. You should report 95925.

Example 2: The neurologist tests a single dermatome on the left and right thigh. Report one unit of 95926.

Beware of unilateral testing: Although the descriptors [...]