Neurology & Pain Management Coding Alert

Simplify your NCS claims with this advice from the experts Multiple nerve conduction studies (NCS) are a common tool of neurologists, especially in diagnosing conditions such as carpal tunnel syndrome (354.0). Unfortunately, payers often misunderstand these tests and will partially reimburse or may deny them altogether.

The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) in Rochester, Minn., offers tips for correctly coding this procedure when you-re using 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), 95903 (... motor, with F-wave study) and 95904 (... sensory).

1. One Nerve, One Charge -- and Maybe Modifier 59  When you-re using 95900, you can't bill for different segments of the same nerve. One nerve equals only one charge.

Try using modifier 59 (Distinct procedural service) when you report 95900 with 95903 or 95904.

Tip: The modifier indicates a distinct procedure, so, technically, you shouldn't have to report it with the procedure code. Including it, however, sometimes helps your claim go through more easily. 2. Distinguish Details Between Codes Don't bill 95900 and 95903 together on the same nerve on the same day, because one is for an F-wave study and the other is without an F-wave study. On the other hand, you can use 95900 and 95903 for different nerves on the same day because they then describe two distinct procedures provided on the same day.

Again, that's where modifier 59 can help.

Neurologists report that carriers frequently deny payment when the physician bills 95900 and 95903 for the same patient in the same visit. These codes have been subject to a Correct Coding Initiative (CCI) -edit- that is designed to detect unbundling or splitting of CPT codes, such as reporting separate codes for related services that are supposed to be covered by one comprehensive code.

The government is attempting to detect unbundling for 95900 and 95903 billed to the same nerve. Nonetheless, you can bill 95900 and 95903 to the same patient on the same day when the physician tests multiple nerves (some with and some without F-wave studies), says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside. 3. Beware of Modifier 51   Modifier 51 (Multiple procedures) is not appropriate when reporting nerve conduction studies performed on multiple nerves (95900-95904). Although some carriers have insisted that you append modifier 51 to these procedure codes if your neurologist tested multiple nerves on the same day, this is incorrect coding. The AMA concurs with the AANEM on this issue.

Here's why: Relative values for these codes were deliberately set low to reflect that physicians usually perform these procedures multiple times on a patient during a single [...]