Orthopedic Coding Alert

You can report nerve conduction with biopsy, injections, and arthrocentesis.

The most recent CCI edits (19.0) allow you to report nerve conduction with various other procedures, provided you can clearly identify these as distinct services. You may report these together and avoid missing on your deserved payment. "Nerve conduction studies are ordered to evaluate the functional status of nerves, most commonly to fully diagnose carpal tunnel syndrome, or other peripheral nerve injuries, such as cubital tunnel syndrome or tarsal tunnel syndrome. They are also used to evaluate possible cervical or lumbar radiculopathies. They may also be used in the cases of documented nerve injuries to evaluate the status, or lack thereof, of nerve recovery, and can be used to help make the diagnosis of more systemic nerve disorders," says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C.

Append Modifier to 95907-95913

Codes 95907 (Nerve conduction studies; 1-2 studies) -- 95913 (Nerve conduction studies; 13 or more studies) are column 2 codes for some other procedure codes but a modifier is allowed in order to differentiate between the services provided. You append modifier 59 (Distinct procedural service) to 95907-95913 when reporting these codes together.

You can report nerve conduction (95907-95913) with muscle biopsy codes 20205 (Biopsy, muscle; deep) and 20206 (Biopsy, muscle, percutaneous needle) and also the vertebral body biopsy code 20250 (Biopsy, vertebral body, open; thoracic).

You can also report 95907-95913 with the injection procedures like injection in the fascial cord, 20527 (Injection, enzyme [eg, collagenase], palmar fascial cord [ie, Dupuytren’s contracture]) and that into the tendon sheath or ligament, 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [eg, plantar "fascia"]).

When your surgeon does a nerve conduction study (95907-95913) with arthrocentesis, you may claim for both procedures. You can report codes 20600 (Arthrocentesis, aspiration and/or injection; small joint or bursa [eg, fingers, toes]), 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]), and 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) with 95907-95913 and append modifier 59 to 95907-95913.

Other codes that you can possibly report with 95907-95913 include 20150 (Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incision), 20950 (Monitoring of interstitial fluid pressure [includes insertion of device, e.g., wick catheter technique, needle manometer technique] in detection of muscle compartment syndrome), 20956 (Bone graft with microvascular anastomosis; iliac crest), and 20957 (Bone graft with microvascular anastomosis; metatarsal).

Keep in mind: You cannot report 95907-95913 with cranial tongs and caliper or spinal grafts, i.e. 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]), 20931 (Allograft, structural, for spine surgery only [List separately in addition to code for primary procedure]), and 20937 (Autograft for spine surgery only [includes harvesting the graft]; morselized [through separate skin or fascial incision] [List separately in addition to code for primary procedure]).

Editor’s note: Additional information about CCI edits is available at http://www.cms.hhs.gov/NationalCorrectCodInitEd.