Neurology & Pain Management Coding Alert

Question: In the October Neurology Coding Alert on page 11, nerve conduction studies (95900-95904) that might take longer than expected are referenced. How can you use a prolonged care procedure code (99354-99360) with this study? I was under the impression that prolonged care could only be used with an E/M code.

Anonymous Wyoming Subscriber

Answer: The article cited by this reader noted that patients frequently present to neurologists with an unspecified source of painlike the symptom-based diagnosis pain in limb (729.50). In these instances the physician might perform nerve conduction studies, but they may take longer than expected because of sensitivity in the limb or because multiple sites must be tested.

When this occurs, the best option is to code the study with modifier -22 (unusual procedural services), which can be assigned appropriately to this type of service and is not restricted solely to evaluation and management codes. The neurologists documentation, however, must be very clear about why the procedure took an inordinate amount of time. Insurance carriers will demand to review the documentation to determine whether the neurologist can demonstrate that his efforts took substantially longer than normal.