Neurology & Pain Management Coding Alert

Question:  I’m looking for help with billing a peripheral nerve block on the same day as a nerve conduction study. I know that CCI edits list 95904 as a component of comprehensive code 64450, and that you cannot report both services by appending a modifier. Do you know the rationale for that edit? And is it possible to bill these two services together and get both paid?

Delaware Subscriber

Answer: Your first step toward a more compliant claim is to remember that 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory) is no longer effective, under CPT^® 2013. Seven new codes specify the number of studies conducted so you would report the one that reflects your provider’s service (such as 95907, Nerve conduction studies; 1-2 studies). The same edits apply, however, that did with 95904.

If the payer in question is Medicare or a private payer following Medicare’s CCI bundling edits, you will not be able to separately bill both the nerve conduction study and 64450 (Injection, anesthetic agent; other peripheral nerve or branch) if the same provider performed both services on the same patient on the same date of service.

The bundling edit cannot be bypassed with modifier 59 (Distinct procedural service) or other modifiers. Payers following the edits will only process 64450 for payment.

Rationale: The CCI edit is based on "Standards of medical/surgical practice." Chapter 1 of the CCI manual states, "Services integral to HCPCS/CPT code defined procedures are included in those procedures based on the standards of medical/surgical practice. It is inappropriate to separately report services that are integral to another procedure with that procedure. Many NCCI edits are based on the standards of medical/surgical practice. Services that are integral to another service are component parts of the more comprehensive service. When integral component services have their own HCPCS/CPT codes, NCCI edits place the comprehensive service in column one and the component service in column two. Since a component service integral to a comprehensive service is not separately reportable, the column two code is not separately reportable with the column one code."