Neurology & Pain Management Coding Alert

Question: Due to repeat testing in edrophonium testing for myasthenia gravis, our physician spent around 90 minutes for the test. Can we report prolonged service codes in this situation? Please advise.

Ohio Subscriber

Answer: You report 95857 (Cholinesterase inhibitor challenge test for myasthenia gravis) for the edrophonium test. This test is used to differentiate myasthenia gravis from cholinergic crisis and Lambert-Eaton myasthenic syndrome. Your physician has completed a repeat testing, which implies that multiple doses of edrophonium may have been used. Only report a single unit of 95857, however, regardless of the number of doses your physician injects for the testing.

The prolonged length of time is because there needs to be a waiting period between consecutive doses. This account for the extra time your physician needs to complete the test when multiple doses are required. This extended time is not beyond the usual service, so you do not report prolonged services codes 99354- 99357 (Prolonged service in the inpatient or observation setting …) with 95857.

During the waiting period between the doses, your physician will monitor the patient for any likely complications. Should any complication arise, you can append modifier 22 (Unusual procedural service) to 95857 if you have supporting documentation for the services provided. However, note that some payers may not accept modifier 22 as 95875 does not have a global period, i.e. it is not a surgical procedure.

Note: Medicare has set the MUE limit for this code to “1” so routine reporting of multiple units of service for the repeat testing is also not an option.