Neurology & Pain Management Coding Alert

Question: I reported 95925 x 4 with modifier -51 appended to the second, third and forth units, for testing of four sites of a patient's arm. The payer denied the claim. Is this correct?

Oklahoma Subscriber

Answer: You should report evoked potentials - including 95925 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs), 95926 (... in lower limbs) and 95927 (... in the trunk or head) - only once per session, regardless of the number of nerves or skin sites the neurologist tests. Do not report multiple units with modifier -51 (Multiple procedures) attached: The code descriptors for evoked potentials already specify "any/all peripheral nerves or skin sites."
 
CPT and payers consider 95925-95927 to be bilateral codes. Therefore, if the physician provides testing on only one limb (for instance, a single arm or leg), you should append modifier -52 (Reduced services) to the appropriate evoked potential code to claim a reduced service.
 
For example, if the neurologist tests three sites on the left leg and three sites on the right leg, report 95926. If the neurologist tests five sites on the left leg and no sites on the right leg, report 95926-52.