Ncs nerve conduction studies - comparisons

cling2me2

Contributor
Messages
12
Best answers
0
Hello.
I have searched and cannot find specific guidance related to if the "Comparison Summary" Studies can be counted. I am receiving many UHC denials.

I understand that we count each nerve OR branch of a nerve (ie RT Ulnar Seg Motor ABD and Right Ulnar Seg Motor FDI are counted separately, as they are listed individually in Appendix J).

I actually have 2 issues - UHC is denying the separate branches of the nerve stating the nerve can only be counted once despite Appendix J. I am appealing these. Has anyone else had this problem with UHC and have you been successful in your appeals?

My other issue is my testing provider, who is ABPTS Board Certified in Clinical Electrophysiology Testing & credentials PT, PMSK, ECS, and I disagree on whether or not the comparison studies can be counted separately. (Again these are being denied by UHC as we are over-coding.)

Example:
MOTOR SUMMARY
Right Median Motor (ABD Poll Brev)
Right Ulnar Seg Motor (ABD Dig Minimi)
Right Ulnar Seg FDI Motor (FDI)

SENSORY SUMMARY
Left Dors Cutan Sensory (Dorsum 5th MC)
Right Dor Cutan Sensory (Dorsum 5th MC)
Right Median D2 Sensory (2nd Digit)
Right Radial Sensory (1st Digit)
Right Ulnar D5 Sensory (5th Digit)

SENSORY COMPARISON SUMMARY

Right Median/Radial Sen Comparison (Digit 1) (Median Wst, Radial Wst)
Right Median/Ulnar Sen Comparison (Digit 4) (Median Wst, Ulnar Wst)

MOTOR COMPARISON SUMMARY
Right 2nd Lumb-Interos Motor Comparison (2nd Lumb Interos) (Median Wrist, Ulnar Wrist)

The testing provider is counting this as 11 nerves = 95912.
I've been told that the Comparisons don't count separate, so I would get 8 nerves = 95910.

Any help/advice / reference material that you could provide to me would be Greatly appreciated!
Thanks! Tina
 
Last edited:

marvelh

Expert
Messages
302
Location
Denver Colorado
Best answers
0
SENSORY COMPARISON SUMMARY
Right Median/Radial Sen Comparison (Digit 1) (Median Wst, Radial Wst)
Right Median/Ulnar Sen Comparison (Digit 4) (Median Wst, Ulnar Wst)

Typically the comparison studies are considered to be separate NCS studies, i.e. the physician performed a separate sensory NCS on the Right median nerve to Digit 1 AND a separate NCS on the Right Radial nerve to Digit 1. They compare the findings of the two separate studies to help with the diagnosis. Similarly the Right median to Digit 4 and the Right Ulnar to Digit 4 are 2 separate studies that the physician then compares the results to help determine the final diagnosis.

The fourth digit has sensory innervation from both the median & ulnar nerves. Likewise, digit 1 has joint innervation from the median & radial nerves. See attached illustration...
sensory nerve innervation of hand.jpg
 

LyndseyK

New
Messages
9
Best answers
0
We've had some disagreements about this and have been told different answers. AANEM told us you can count median to second and median to fourth separate. However, CMS has told us only nerves listed with a letter (A,B,C, etc.) in Appendix J in the CPT book can be counted. The nerves under these headings with a numeral in front of them can’t be counted. I also read an article from AHIMA that seems to agree with CMS, "CPT Appendix J lists the nerves that can be tested and coded under nerve conduction study codes. The branches of each nerve are also listed, but the unit of service is limited to the nerve and not the branches." https://newsletters.ahima.org/newsletters/Code_Write/2013/April/nerve_conduction.html

Does anyone know which is correct so we can put an end to this debate?
 

salindarose

Contributor
Messages
10
Location
Kimball, MI
Best answers
0
I would love to revisit this thread. Anybody have concrete answers? I am leaning toward the CMS answer of only the nerves listed with a letter in Appendix J but am still finding a few articles that state otherwise.
 

marvelh

Expert
Messages
302
Location
Denver Colorado
Best answers
0
Per CPT® Assistant. December 2017; Volume 27: Issue 12 Medicine: Neurology and Neuromuscular Procedures

Question: How should an ulnar motor nerve conduction study with recording from the abductor digiti minimi and the first dorsal interosseous be reported?​

Answer: Code 95907, Nerve conduction studies; 1-2 studies, should be reported for this procedure. The abductor digiti minimi and the first dorsal interosseous represent two separate conduction studies.​


Note the last sentence that CPT states that the ulnar motor nerve to the ADM (I. H. 1.) and the ulnar motor nerve to the 1st DI (I. H. 3.) are two separate studies. The reference to each nerve study is from Appendix J in the CPT book

And the following is from the CPT® Assistant. March 2013; Volume 23: Issue 3 Nerve Conduction Studies (Codes 95907-95913)

Question: How would you report a typical carpal tunnel syndrome patient with nocturnal right hand numbness, in conjunction with needle EMG of the right deltoid, triceps, extensor digitorum communis, flexor carpi radialis, ab-ductor pollicis brevis, and first dorsal interossei, and the following NCSs:​
bilateral median nerve motor nerve without F-wave, two point stimulation,​
unilateral ulnar motor nerve without F-wave, two point stimulation,​
bilateral median nerve sensory,​
unilateral ulnar nerve sensory,​
unilateral median nerve midpalmar mixed, and​
unilateral ulnar nerve midpalmar mixed.​
Answer: Report code 95910 for eight NCSs performed, and code 95886 for complete limb EMG​

Note that CPT is allowing for separate "counting" of median sensory (I. D.) and median nerve midpalmar mixed (I. D. 6.) as well as separate "counting" of bilateral testing. The 8 NCS performed were
  1. right median nerve motor nerve without F-wave, two point stimulation
  2. left median nerve motor nerve without F-wave, two point stimulation
  3. unilateral ulnar motor nerve without F-wave, two point stimulation
  4. right median nerve sensory
  5. left median nerve sensory
  6. unilateral ulnar nerve sensory
  7. unilateral median nerve midpalmar mixed
  8. unilateral ulnare midpalmar mixed.

If your physician is performing more NCS than what is listed in the Appendix J table to diagnose in 90% of patients with that condition, he/she should have an additional statement as to why it was medically necessary to perform more NCS on that patient. For example, if a patient had a final diagnosis of unilateral CTS and your provider performed 10 NCS on this patient, he/she should include the medical necessity as to why it was necessary to exceed the 7 maximum NCS for that diagnosis. Note that the table doesn't state 100% of all patients, just 90%. In some cases, due to equivocal NCS results, i.e. slightly abnormal, he/she may need to do additional NCS testing to make a final diagnosis. Note that in the Appendix J table, it allows a total of 9 NCS for a final diagnosis of unilateral pain, numbness, or tingling meaning that the physician needed to do additional testing because either the patient's findings were either normal or not straightforward abnormal. The NCS findings could not provide an unequivocal diagnosis given the patient's symptoms of pain, numbness or tingling.

Many payers include this Appendix J table information in their electrodiagnostic testing claims processing logic software. For a reported diagnosis of G56.01 the payer would expect to find 95910 or less NCS billed and would likely deny any of the higher NCS codes - 95911 - 95913. If the physician performed 11 NCS and billed 95912, the report should include the "why it was necessary" explanation for the NCS diagnostic testing and you would need to appeal the denial.

The information in Appendix J was originally created by the AANEM, the physician board certification organization for electrodiagnostic testing, and provided to the AMA in creation of Appendix J. Here is a link to AANEM information from Sept 2019 https://tinyurl.com/AANEMcoding that also supports that each nerve segment listed in Appendix J should be counted:
"...Appendix J’s list of nerves refers to a different nerve and should be counted as an individual unit. For example, the ulnar motor nerve has 4 different nerve segments that can each be counted separately toward the total..."​
 
Top