Part B Insider (Multispecialty) Coding Alert

Published on Mon Sep 11, 2006 PDF

If you perform tests on the same nerve, report the more extensive code

When your neurologist performs a nerve conduction study (NCS), whether he uses F-waves can affect how you report the procedure. Here's why.

Example: The neurologist conducts a nerve conduction study (NCS) without F-waves on the ulnar nerve (95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study). Realizing he requires more data, he performs NCS on the same nerve a second time, but with F-waves (95903, ... motor, with F-wave study). Based on the neurologist's documentation of nerve conduction with and without F-wave, the coder reports separate units of 95900 and 95903.

Snag: The National Correct Coding Initiative bundles 95900 to 95903 for tests on the same nerve. Therefore, in this case the coder should have reported only the more extensive procedure (95903). You should always keep an updated version of the NCCI handy and constantly refer to it.

Remember: Anytime you report multiple CPT codes on a claim form, you must consider that one or more of the services you are reporting could be an included component of another, more extensive procedure that you've also claimed. Reporting an included service separately is called "unbundling," and it's one of the most common problems with Medicare claims, according to CMS.

Bonus: You can access the NCCI edits without cost at the CMS Web site:
www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. From there, you can also access the NCCI overview page which includes links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual and an NCCI Question-and-Answer page.