Neurology & Pain Management Coding Alert

Question: How should we bill if a technician, rather than the neurologist, conducts diagnostic tests such as nerve conduction studies or electromyography? Should we report the services under the physicians ID number? Must the physician be on-site during the testing?

Pennsylvania Subscriber
 
Answer: Different payers set different rules for physician supervision, and you should contact your individual payers to see what they have to say about this.
 
Medicare sets the standard in this regard, and it provides very specific rules regarding physician supervision. In most cases, a technician can provide testing, and you would bill the procedures just as if the neurologist provided them, as long as the physician is available to supervise the test and review the results.
 
Specifically, during nerve conduction studies (95900-95904) or electromyography (for example, 95860-95870), the neurologist must provide direct supervision of the non-physician employee providing the test. This means:
  the physician must be present in the office suite. The physician need not be present in the room during the procedure (unless otherwise required by state law).
  the physician must be immediately available to furnish the nonphysician employee with assistance and direction, if needed, throughout the performance of the entire procedure. So, for instance, the technician provides NCS testing for a patient in the neurologist's office, using equipment owned by the neurologist. The neurologist is on-site in the next examination room over during the testing, and therefore available to provide assistance and direction to the technologist, if needed.
 
You would report 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) with no modifiers appended, just as if the neurologist had conducted the test.