Neurology & Pain Management Coding Alert

Take the fear out of modifier 59 using the scenarios our experts reveal Choosing the appropriate code to describe your nerve conduction test can prove to be a challenging proposition. Listen to what our coding experts have to say to help you make the right choice with no second guessing. How to Differentiate Between the 3 Possibilities When you-re looking at nerve conduction study (NCS) coding, you have three options: - 95900 -- Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study - 95903 -- - motor, with F-wave study - 95904 -- - sensory. The first thing you need to remember about these nerve conduction test codes is that you can report only one of the codes when a neurologist performs the study on the same nerve at multiple sites. "CPT codes 95900 and 95904 are billed by units -- nerves -- and can be billed only once per nerve," says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, with the University of Rochester Medical Center department of neurology. "Code 95903 includes both F-wave and motor conduction studies. By National Correct Coding Initiative exclusion, they cannot be billed at the same time on the same nerve as code 95900." Remember: Codes 95900, 95903 and 95904 are "each nerve" codes, according to their descriptors. CPT's parenthetical remark with these codes notes that you should "report 95900, 95903 and/or 95904 only once when multiple sites on the same nerve are stimulated or recorded." Make sure you follow this guide and aren't reporting multiple sites on the same nerve as "each nerve." Know When to Use Modifiers Modifiers can come in handy when coding for nerve conduction studies, as Wink-Sturgeon describes in the following example. A patient undergoes a motor nerve conduction study, which the neurologist performs without F-wave on one nerve. During the same procedure, the neurologist performs a motor nerve conduction study -- this time with F-wave -- on a different nerve. If the neurologist performed these studies separately, you would code for them using 95900 for the first procedure and 95903 for the second. Because the neurologist conducted both tests on the patient at the same time, you should assign modifier 59 (Distinct procedural service) to the second study to indicate that the neurologist performed a separate procedure on a different nerve.- "We use modifier 59 quite a bit in NCS coding," says Meredyth Hurt, CCS-P, with Sky Lakes Medical Center in Klamath Falls, Ore.- She describes the following example: A doctor performs motor nerve testing-(95900) on the median, ulnar and radial nerves on the patient's left side. The doctor then performs a motor F-wave (95903) on the median and ulnar nerves, again on the left side. In this [...]