Wiki Nerve Condution Studies

[ShellieSulzberger]

Can someone assist us with how many nerves - we are finding two of our coders don't agree:

Left Median sensory Orthodromic
Left Median Motor
Left Median F Wave
Left Ulnar Sensory Orthodromic
Left Ulnar Motor
Left Ulnar F-wave
Left Radial sensory


Right Median sensory Orthodromic
Right Median sensory - Antidromic
Right Median Motor
Right Median F Wave
Right Ulnar Sensory Orthodromic
Right Ulnar Motor
Right Ulnar F-wave

 

[mhstrauss]

Can someone assist us with how many nerves - we are finding two of our coders don't agree:

Left Median sensory Orthodromic
Left Median Motor
Left Median F Wave
Left Ulnar Sensory Orthodromic
Left Ulnar Motor
Left Ulnar F-wave
Left Radial sensory


Right Median sensory Orthodromic
Right Median sensory - Antidromic
Right Median Motor
Right Median F Wave
Right Ulnar Sensory Orthodromic
Right Ulnar Motor
Right Ulnar F-wave

I am coming up with 9 studies (CPT 95911) for this example:

1. Left Median sensory Orthodromic
2. Left Median F-wave (includes Motor)
3. Left Ulnar Sensory Orthodromic
4. Left Ulnar F-wave (includes Motor)
5. Left Radial Sensory

6. Right Median sensory Orthodromic (includes Antidromic)
7. Right Median F Wave (includes Motor)
8. Right Ulnar Sensory Orthodromic
9. Right Ulnar F-wave (includes Motor)

Here's a great article outlining the changes made to this codeset last year, if needed for a resource:

http://solutions4mds.com/2013-cpt-coding-changes-–-nerve-conduction-studies/

Hope this helps!

 

[KCDUENAS]

Hi Meagan, I really like your response. I was wondering if you could help me understand sensory/mixed nerves. For example our neurologist performed the sensory NCS on the following:

L Median- Dig II
L Median- Palmar (mixed nerve)

R Median- Dig II
R Median- Palmar (mixed nerve)

L Ulnar- Dig V
L Ulnar- Palmar (mixed nerve)

R Ulnar- Dig V
R Ulnar- Palmar (mixed nerve)

I initially thought to count this as 4 studies as Appendix I does not separate sensory/mixed nerves, however, after reading a coding tip from CPT Assistant (March 2013) I got confused. It states: "A nerve conduction study is counted only once when mulitple sites on the same nerve are stimulated or recorded. Motor, sensory, mixed motor/sensory, or H-reflex tests are each counted per nerve tested."

The last sentence makes me think to count the mixed nerves separate. Thanks for any help in advance!

 

[marvelh]

A mixed nerve has both motor and sensory nerve fibers. When testing the sensory fibers of a mixed nerve, it would be "counted" as a sensory nerve conduction study. There are very few "pure" sensory nerves.

Total of 8 nerves studied.

Appendix J includes a separate listing for each of the following nerve / nerve branches and includes the "Each nerve constitutes one unit of service":

Median sensory to the second digit
Median palmar mixed nerve
Ulnar sensory to the fifth digit
Ulnar palmar mixed nerve​

 

[dnorthrup]

Marvel,

So, if I am understanding you correctly the branches of the sensory nerves can be counted separately.

For example: bilateral sensory Ulnar nerve at the wrist; and bilateral Ulnar dorsal cutaneous sensory nerve could be counted as 4 studies and billed out using 95908 3-4 studies.

 

[marvelh]

I have found the easiest way to understand this is to look at Appendix J in the CPT codebook.

The listing for sensory NCS of
Ulnar nerve to 4th digit and
Ulnar nerve to 5th digit would be considered to be two separate NCS studies.

Likewise sensory NCS of
Ulnar nerve to 4th digit and
Ulnar dorsal cutaneous sensory nerve would be considered to be two separate NCS studies. If performed bilaterally, these four NCS would be coded with 95908 x 1 unit of service.

For motor NCS, the "counting" is the same, in that
Median motor nerve to APB and
Median motor nerve to first lumbrical would be considered to be two separate NCS studies

Likewise motor NCS of
Ulnar motor nerve to ADM and
Ulnar motor nerve to FCR would be considered to be two separate NCS studies. If performed bilaterally, these four motor NCS would be reported with 95808 x 1 unit of service.

Testing of the motor NCS as well as the corresponding F-wave is only "counted" as one NCS. For example,
Median motor NCS to APB and
F-wave study of Median motor to APB would be considered to be a single NCS study, not two NCS.

Appendix J also provides a useful Table of Maximum Number of Studies that many payers incorporate into their coverage policies. The table establishes the reasonable maximum number of studies to arrive at the diagnosis listed in the left column in 90% of patients with that final diagnosis. For example, the reasonable maximum number of studies to diagnosis 90% of patients with bilateral carpal tunnel syndrome, would be 10 total NCS, whereas diagnosis unilateral CTS in 90% of the patients with that condition would require 7 NCS.

Payers and providers need to remember that the Maximum Number of Studies table only covers diagnosis of 90% of the patients with that condition, in that there remains 10% of those patients that may require more. The provider's documentation should indicate the medical necessity for additional studies beyond the Table's reasonable maximum.

Hope this makes more sense now! If not, let me know & we can discuss further!