Orthopedic Coding Alert

Question: We've started to perform nerve conduction studies (NCS) in our office. The equipment vendor recommends billing 95903. Since the procedure is always done bilaterally, and sometimes it is also done a third time, on a different nerve, on one arm, what modifier do I use to describe the third study?

Rhode Island Subscriber

Answer: Depending on the type of study (with or without F-wave) and the type of nerve being tested (motor sensory), you will report 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) 95903 (... motor, with F-wave study) and 95904 (... sensory). Since the CPT code descriptions include the language "each nerve," no modifier is required when the procedure is performed multiple times. You should be able to report the appropriate code(s) as a single line item increasing the units of services as indicated.
 
However, not all carriers adhere to CPT reporting guidelines. Some carriers will require that you report the code as a single line item for each nerve tested with modifier -59 (distinct procedural service) appended to the second and subsequent procedures. Others will not require any modifiers for NCS and ask that you list each incident on a separate line. The best approach is to contact your frequently used payers and determine how they want multiple NCS billed.