Neurology & Pain Management Coding Alert

Question: The patient presented with a complaint of numbness and pain in the left leg. The neurologist performed H-reflex testing on the left leg and on the right leg as a "control." I reported 95934 x 2, but the payer rejected the claim. How should I have coded? Pennsylvania Subscriber Answer: When performing an H-reflex study, the neurologist establishes a "baseline" measurement by testing each side of the patient's body and comparing the response of the "unaffected" muscle to that of the "affected" muscle. As noted by the American Academy of Electrodiagnostic Medicine's (AAEM) "Recommended Policy for Electrodiagnostic Medicine," "H-reflex studies usually must be performed bilaterally because symmetry responses is an important criterion for abnormality."

CPT descriptors for H-reflex codes specify "muscle" rather than "muscles," and the AAEM and Medicare consequently consider these unilateral codes. Therefore, to report a bilateral study, select the appropriate code in this case 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle) and append modifier -50 (Bilateral procedure). Note: Some insurers want bilateral claims listed on two lines, e.g., 95934, 95934-50. Ask your local carrier for its preference prior to billing for these services. In addition, physicians should document that they tested two limbs, and they should identify the nerves evaluated and the H-reflex characteristics, e.g., latency. Reporting 95934 (or 95936, ... record muscle other than gastrocnemius/soleus muscle) x 2 for bilateral testing will, as you have found, result in denial for duplication of services. Note that if only one limb is tested, you should not apply a modifier.