Neurology & Pain Management Coding Alert

Question: Medicare denies claims for modifiers with 95903, 95904, and 95934. We're submitting modifier 26 on 95903/95904 and modifiers 50 and 26 on 95934. We only code for the physician portion of the service. Why are we getting denials?Florida SubscriberAnswer: Each insurance company has its own guidelines for how you should submit claims for 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study), 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory), and 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle). Check with your local carrier regarding these possible preferences:According to Medicare guidelines, you should report the most significant modifier first. In this case, that means listing modifier 26 (Professional component) before modifier 50 (Bilateral procedure).The denial might be related to the quantity of units of service you reported instead of the modifier usage. Most Medicare contractors have limitations on the quantity of units [...]