Billing for NCT
First, make sure you are familliar with the mark up rules for purchased diagnostic tests.
You may ONLY purchase ONE component of the diagnostic test, either the professional (-26) or the technichal component (-TC).
If the doc subs out both components, he cannot bill out the global service under Medicare rules.
If your doc is providing the professional component for other physicians (when he goes into a chiro's office and performs the tests), which would mean he is interpreting the information and writting a report that is then submitted to the requesting doc, you would append the -26 modifier to the codes.
But remember, 95900 and 95903 are reported as 1 unit for each nerve (even if it is performed at a different site on an extention of that same nerve).
95900 is a NCT with F wave
95903 is NCT without F wave
Both of those codes test the "motor" component of a nerve.
95904 tests the "sensory" component of the nerve.
The AMA CPT Assistant states:
"If nerve conduction studies are performed on two different nerves, the first with F-Wave study and the second nerve without F-Wave study, then the first nerve studied would be reported as 95903. Since the second nerve conduction study represents a separate distinct test, then CPT code 95900 may reported in addition to 95903."
If 95900 is submitted with 95903--both reimburse separately...
Also, the appropraite diagnosis codes (that are supported in the medical record) MUST accompany the billing.
Every carrier has a slightly different list and rules that apply - so, billing, as ALWAYS depends on the carriers rules. Check them.
Nerve conduction studies are used mainly for evaluation of paresthesias (numbness, tingling, burning) and/or weakness of the arms and legs. The type of study is determined by the problem.
Here are a list of some common accepted ICD-9 codes for those tests:
192.0 Malignant neoplasm of cranial nerves
192.2 Malignant neoplasm of spinal cord
192.3 Malignant neoplasm of spinal meninges
225.1 Benign neoplasm of cranial nerves
225.3 Benign neoplasm of spinal cord
250.60 Diabetes with neurological manifestations; type II (non insulin dependent type) (NIDDM type)
(adult-onset type) or unspec. type, not stated as uncontrolled
250.61 ; type I (insulin dependent type) (IDDM type) (juvenile type) not stated as uncontrolled
250.62 ; type II (non-insulin dependent type) (NIDDM type) (adult-onset type) or unspec. type,
uncontrolled
250.63 ; type I (insulin dependent type) (IDDM type) juvenile type), uncontrolled
265.1 Other and unspec. manifestations of thiamine deficiency
269.1 Deficiency of other vitamins (vitamin E, vitamin P)
272.5 Lipoprotein deficiencies
333.6 Idopathic torsion dystonia
333.7 Symptomatic torsion dystonia
333.81 - 333.89 Fragments of torsion dystonia
334.1 Hereditary spastic paraplegia
335.0 Werdnig-Hoffmann disease
335.10 Spinal muscular atrophy, unspec.
335.11 Kugelberg-Welander disease
335.19 Other spinal muscular atrophy
335.20 - 335.29 Motor neuron disease
335.8 Other anterior horn cell diseases
335.9 Anterior horn cell disease, unspec.
336.0 - 336.9 Other diseases of spinal cord
337.0 Idiopathic peripheral autonomic neuropathy
337.1 Peripheral autonomic neuropathy in disorders classified elsewhere
337.20 – 337.29 Reflex sympathetic dystrophy
337.3 Autonomic dysreflexia
337.9 Unspecified disorder of autonomic nervous system
340 Multiple sclerosis
341.0-341.9 Other demyelinating disease of central nervous system
342.00 – 342.92 Hemiplegia and hemiparesis
343.0 – 343.9 Infantile cerebral palsy
344.00 – 344.09 Quadriplegia and quadriparesis
344.1 Paraplegia
344.2 Diplegia of upper limbs
344.30 – 344.32 Monplegia of lower limb
344.40 – 344.42 Monoplegia of upper limb
344.5 Unspecified monoplegia
344.60 Cauda equina syndrome, without mention of neurogenic bladder
344.61 Cauda equina syndrome, with neurogenic bladder
344.89 Other specified paralytic syndrome
344.9 Paralysis, unspec.
350.2 Atypical face pain
351.0 Bell's palsy
351.8 Other facial nerve disorder
351.9 Facial nerve disorder, unspec.
352.3 Disorders of pneumogastric (10th) nerve
352.4 Disorders of accessory (11th) nerve
352.5 Disorders of hypoglossal (12th) nerve
352.6 Multiple cranial nerve palsies
353.0 Brachial plexus lesions
353.1 Lumbosacral plexus lesions
353.2 Cervical root lesions, not elsewhere classified
353.3 Thoracic root lesions, nec
353.4 Lumbosacral root lesions, nec
353.5 Neuralgic amyotrophy
353.8 Other nerve root and plexus disorders
353.9 Unspecified nerve root and plexus disorder
354.0-354.9 Mononeuritis of upper limb and mononeuritis multiplex
355.0-355.9 Mononeuritis of lower limb and unspec. Site
356.0-356.9 Hereditary and idiopathic peripheral neuropathy
357.0 Inflammatory and toxic neuropathy; acute infective polyneuritis
357.1 ; polyneuropathy in collagen vascular disease
357.2 ; polyneuropathy in diabetes
357.3 ; polyneuropathy in malignant disease
357.4 ; polyneuropathy in other diseases classified elsewhere
357.5 ; alcoholic poluneuropathy
357.6 ; polyneuropathy due to drugs
357.7 ; polyneuropathy due to other toxic agents
357.81 Chronic inflammatory demyelinating polyneuritis
357.82 Critical illness polyneuropathy Acute motor neropathy
357.89 Other inflammatory and toxic neuropathy
358.00-358.01 Myasthenia gravis
358.1 Myasthenia syndromes in diseases classified elsewhere
358.2 Toxic myoneural disorders
358.8 Other specified myoneural disorders
358.9 Myoneural disorders, unspecified
359.0 Muscular dystrophies and other myopathies; congenital heredity muscular dystrophy
359.1 ; hereditary progressive muscular dystrophy
359.2 ; myotonic disorders
359.3 ; familial periodic paralysis
359.4 ; toxic myopathy
359.5 ; myopathy in endrocrine disease classified elsewhere
359.6 ; symptomatic inflammatory myopathy in diseases classified elsewhere
359.81 Critical illness myopathy
Acute nectrotizing myopathy
Acute quadriplegic myopathy
Intensive care (ICU) myopathy
Myopathy of critical illness
359.89 Other myopathies
359.9 Myopathy, unspecified
376.82 Myopathy of extraocular muscles
378.00-378.9 Strabismus and other disorders of binocular eye movement
458.0 Orthostatic hypotension
478.75 Laryngeal spasm
564.6 Anal spasm
710.3 Dermatomyositis
710.4 Polymyositis
710.5 Eosinophilia myalgia syndrome
721.0 Cervical spondylosis without myelopathy
721.1 Cervical spondylosis with myelopathy
721.2 Thoracic spondylosis without myelopathy
721.3 Lumbosacral spondylosis without myelopathy
721.41 Spondylosis with myelopathy, thoracic region
721.42 Spondylosis with myelopathy, lumbar region
722.0-722.11 Displacement of cervical, thoracic, or lumbar intervertebral disc without myelopathy
722.2 Displacement of intervertebral disc, site unspec. without myelopathy
722.4 Degeneration of cervical intervertebral disc
722.51 Degeneration of thoracic or thoracolumbar intervertebral disc
722.52 Degeneration of lumbar or lumbosacral intervertebral disc
722.6 Degeneration of intervertebral disc, site unspec.
722.70-722.73 Intervertebral disc disorder with myelopathy
722.80-722.83 Postlaminectomy syndrome
722.91-722.93 Other specific disc disorder
723.0 Spinal stenosis in cervical region
723.4 Brachial neuritis or radiculitis NOS
723.5 Torticollis, unspec.
724.00-724.09 Spinal stenosis, other than cervical
724.1 Pain in thoracic spine
724.2 Lumbago
724.3 Sciatica
724.4 Thoracic of lumbosacral neuritis or radiculitis, unspec.
724.5 Backache, unspec.
728.0 Infective myositis
728.85 Spasm of muscle
728.87 Muscle weakness
729.2 Neuralgia, neuritis and radiculitis, unspec.
729.5 Pain in limb
729.89 Other musculoskeletal symptoms referable to limbs
736.05 Wrist drop (acquired)
736.06 Claw hand (acquired)
736.09 Other acquired deformities of forearm, excluding Fingers
736.79 Other acquired deformities of ankle and foot
781.4 Transient paralysis of limb
781.7 Tetany
782.0 Disturbance of skin sensation
784.49 Other disturbance, including spasmodic dysphonia
788.20 Retention of urine, unspecified
788.21 Incomplete bladder emptying
788.29 Other specified retention of urine
788.31 Urge incontinence
788.41 Urinary frequency
952.00-952.09 Spinal cord injury without evidence of spinal bone injury, cervical
952.10-952.19 Spinal cord injury without evidence of spinal bone injury, dorsal (thoracic)
952.2 Lumbar spinal cord injury without evidence of spinal bone injury
952.3 Sacral spinal cord injury without evidence of spinal bone injury
952.4 Cauda equina spinal cord injury without evidence of spinal bone injury
952.8 Multiple sites of spinal cord injury without evidence of spinal bone injury
952.9 Unspecified site of spinal cord injury without evidence of spinal bone injury
953.0-953.9 Injury to nerve roots and spinal plexus
954.0-954.9 Injury to other nerve(s) of trunk, excluding shoulder and pelvic girdles
955.0-955.9 Injury to peripheral nerve(s) of shoulder girdle and upper limb
956.0-956.9 Injury to peripheral nerve(s) of pelvic girdle and lower limb
957.0-957.9 Injury to other and unspecified nerves
