Neurology & Pain Management Coding Alert

Report 95900, 95903 and/or 95904 only once when you stimulate multiple sites on the same nerve

If denials for nerve conduction studies (NCS) have left you a little unnerved, you-ll soon be able to look to CPT 2006 to make your job easier. 

The AMA will include an -Appendix J- in CPT 2006 listing which nerves count as separate -units.- With this list of separately reportable procedures in hand, you can easily identify the correct type and number of NCS codes to report. Report 1 Unit per Listed Nerve  For each separately reportable nerve you test, you may report one unit of service of the corresponding NCS code, 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 AMA has arranged the list of nerves by type (motor or sensory/mixed) and location (upper extremity, lower extremity, cranial nerves and trunk, and root stimulation).

Free resource: For a quick and convenient list of separately billable nerves, see -Clip and Save: Keep This List Handy for Easy NCS Coding- later in this issue.
 
-I think this method should make billing for NCS much easier for most coders,- Busis says. -Determining the correct number of separately billable studies should now be as simple as consulting a list.-

Warning: The number of studies does not necessarily equal the number of units, says Tiffany Schmidt, JD, policy director for the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). If you stimulate and record multiple sites on the same nerve, you should only report one unit of the appropriate NCS code. Make Your Case With Modifiers When Mixing Studies You can report more than one type of NCS at the same time--and even multiple units of each type of study--as long as each study occurs on a separately billable nerve and you meet medical-necessity requirements for the services provided.

Suppose you provide study with F-wave on the ulnar nerve to the abductor digiti minimi, study without F-wave on the ulnar nerve to the first dorsal interosseous, and a study on the ulnar dorsal cutaneous sensory nerve.

In this case, if you check the list of nerves, you find that each of these nerves counts as a separate unit. Therefore, you should report 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) for the ulnar nerve to the first dorsal interosseous, 95903 (- motor, with F-wave study) for the ulnar nerve to the abductor digiti minimi, and 95904 (... sensory) for the ulnar dorsal cutaneous sensory nerve.

If you stop your coding there, however, don't be surprised to see reduced reimbursement. [...]