Neurology & Pain Management Coding Alert

Many carriers do not understand that multiple nerves may need to be tested in a nerve conduction study (NCS) and often do not acknowledge despite the descriptions for 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), 95903 (... motor, with F-wave study) and 95904 (... sensory or mixed) that each nerve tested is separately reimbursable, says Neil A. Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside. As a result, a bill for four units of 95900 (on four separate nerves) is often reduced by carriers to payment for only one unit (as if only one nerve had been tested).

Other reasons given by carriers for reductions or denials often include ICD-9 codes that do not support medical necessity and lack of supporting documentation.

Billing for Nerves Tested

Many coders often overlook the critically important language following the definition of the three codes that specifically states they should only be reported once when
multiple sites on the same nerve are stimulated or recorded. For example, if an NCS with F-wave study (95903) was performed on three sites along one nerve, two sites along another nerve, and four sites along a third nerve, you should bill for three units (the total number of nerves tested), not nine units (the total number of sites along the nerves tested) of 95903.

Billing 95900 with 95903

Busis says some payers uniformly reject 95900 and 95903 when they are billed together, indicating that the first code is a component of the second. But this is true only if they are reported for the same nerve, not if the NCS without F-wave (95900) was performed on one nerve and the NCS with F-wave (95903) on another.

The key, says Tiffany Eggers, JD, MPA, policy director and legislative counsel for the American Association of Electrodiagnostic Medicine, is to ensure that documentation sent with the claim clearly shows that separate nerves were tested.

Otherwise, carriers are going to look at the two codes, decide you are trying to unbundle and deny the claim, she says.

Use of Modifiers with NCS

HCFA has suggested that modifier -59 (distinct procedural service) be used with each NCS code following the primary to indicate that they represent separate services performed on different nerves. Busis says this may attain reimbursement, but it is incorrect coding. These codes are designed to be billed per nerve with no modifier needed, yet payers generally do not recognize this. Until HCFA releases more clarifying information, using modifier -59 may be the only way to obtain optimum reimbursement for multiple testing at different sites.

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