Neurology & Pain Management Coding Alert

Question: We receive denials for 95900 whether we report it with or without modifier 59. What is the correct way to bill this type of nerve conduction study?

Missouri Subscriber Answer: Before reporting modifier 59 (Distinct procedural service) with 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), verify the nerves your neurologist treated.

According to Correct Coding Initiative (CCI) edits, you should append modifier 59 to codes 95900 or 95903 (- motor, with F-wave study) to override bundling when your physician treats different nerves on one side or the same nerve on a different side. If your physician's treatment doesn't meet these criteria, the carrier will deny your claim.

Another modifier: Some neurologists own the equipment they use for these studies, but others don-t. If your neurologist does not own the equipment, append modifier 26 (Professional component) to the procedure code. If you-re not reporting modifier 26, that might be part of the reason for the carrier's denial.

Example: You receive charges for 95900 (two units), 95903 (three units), 95904 (four units) and 95860 (one unit). Report it as:
 
- 95860-26 (Needle electromyography; one extremity with or without related paraspinal areas): one unit

- 95900-26-59: two units

- 95903-26-59: three units

- 95904-26: four units.

Last resort: If the carrier still denies your claim, call and explain the procedure to your representative. If that doesn't work, submit an appeal and mark the report to show the individual studies that the payer should separately reimburse.