Pulmonology Coding Alert

Question: Our office just came across a case of ANS testing. Is it a payable service, i.e., can we bill this code (by itself) to Medicare or any commercial payer? And if yes, then what is the fee schedule? What are the codes bundled with it? Also, explain the service in brief.

Idaho Subscriber

Answer: The most reasonable and recommended CPT® code for ANSAR testing is 95943 (Simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced [deep] breathing, Valsalva maneuvers, and head-up postural change). However, ensure before reporting the code that your provider’s documentation indicates that both the sympathetic and parasympathetic function testing were performed as identified by the code’s descriptor.Not just any physician can report this service. It requires proper certification.

According to Novitas Solutions, “Physicians must have knowledge, training, and expertise to perform and interpret these tests, and to assess and train personnel working with them. This training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program or must reflect extensive continued medical education activities. If these skills have been acquired by way of continued medical education, the courses must be comprehensive, offered or sponsored or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States, and designated by the American Medical Association (AMA) or American Osteopathic Association (AOA) as category I credit.”

Code 95943 is bundled with 93040 (Rhythm ECG, 1-3 leads; with interpretation and report), 95921 (Testing of autonomic nervous system function; cardiovagal innervation [parasympathetic function], including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio), 95922 (Testing of autonomic nervous system function; vasomotor adrenergic innervation [sympathetic adrenergic function], including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt), and 95924 (Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt)and these services can’t be reported together.

Many Medicare contractors have local coverage policies for Autonomic Function Testing, which include the criteria for coverage for these diagnostic tests. Some commercial payers might accept 95943, but others consider ANSAR testing to be experimental and investigational. Aetna, for example, “considers ANSAR (ANX 3.0) test experimental and investigational in the evaluation of paradoxical parasympathetic syndrome because its clinical value has not been established,” according to its policy number 0485. If a payer takes this stance, you won’t be reimbursed for the service. Practices should review the patient’s insurance coverage for this type of diagnostic testing. The patient should be notified of non-coverage prior to the testing being performed.

You should look up your state’s Local Coverage Determination (LCD) as Medicare places strict stipulations for billing this procedure. The fee schedule for this code has not been published, so unfortunately we cannot provide that information to you.

ANSAR: Our body’s autonomic nervous system is divided into two parts: the parasympathetic (digestion, healing, blood flow and respiration) and the sympathetic (“fight or flight” response). When there is an imbalance in the autonomic nervous system, there is a reason. ANSAR testing can detect many conditions in the early stages, when treatment can be most effective. Cardiovascular disease, diabetes,Parkinson’s disease, multiple sclerosis, chronic fatigue syndrome and high blood pressure are just some of the conditions that can be identified and measured with the ANSAR test.