Ncs

ShellieSulzberger

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If a provider is doing a nerve conduction study (9591X) – here is the guidelines from CPT and LCD:

Codes 95907-95913 describe one or more nerve conduction studies. A single conduction test is defined as a sensory conduction test, a motor conduction test with or without an F wave test, or an H-reflex test. Each type of study (sensory, motor with or without F wave, H reflex) for each nerve is counted as a distinct study when determining the number of studies billed.

Each type of study is counted only once when multiple sites on the same nerve are stimulated and recorded. The number of tests (sensory, motor with or without F wave, H reflex) per nerve should be added to determine the code to be billed.

So how many nerves do I have for sensory and then for motor? So under sensory – is the median wrist digit 2 and median wrist thumb counted as one or 2 – so for sensory are there 5 or 4 and I think for motor I have 4 – can you confirm? So if I am thinking correctly I either have 8 or 9 total nerves. I think I can count the nerve twice if one is sensory and one is motor???

Sensory Nerve Conduction Study
Right side:
Median wrist digit 2
Ulnar wrist digit 5
Sural calf ankle
Superficial lateral leg peroneal ankle
Median wrist – thumb - radial wrist - thumb


Motor Nerve Conduction Study
Right side:
Median APB wrist and elbow
Ulnar ADM wrist and elbow
Peroneal – EDB – ankle and fib head
Tibial – AH – ankle and pop fossa

if you can offer any guidance please email me at: ssulzberger@ccipro.net
 

marvelh

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The CPT Section guidelines continue on to state "For a list of nerve, see Appendix J". Under Appendix J, I. D. 1. median sensory nerve to the first digit and I. D. 2. median sensory nerve to the second nerve are considered to be two separate sensory nerve conduction studies. The following is from the March 2013 CPT Assistant:
[INDENTQuestion: 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.][/INDENT]

Note that CPT separately counts the median nerve sensory separate from the median nerve midpalmar mixed.

Additionally, a motor nerve conduction study is considered as a separate study from a sensory nerve conduction study. So a sensory NCS of the Median sensory nerve to D2 is counted separately from a motor NCS of the Median motor nerve to APB. The following is again from the March 2013 CPT Assistant:
Question: What is the appropriate code to report for the following in which a typical L5 radiculopathy patient with shooting pain radiating down the leg to the big toe, who underwent the following NCS:
unilateral sural sensory nerve,
unilateral peroneal motor nerve recording from extensor digitorum brevis (EDB) with F-wave, and
unitateral tibial motor nerve with F-wave?

Answer: Report code 95908, as three NCSs were performed.

Question: If everything in the procedure as mentioned in the previous question was performed, in addition to bilateral superficial peroneal sensory nerve conduction studies and needle EMG in one leg of the tibialis anterior, medial gastrocnemius, vastus lateralis, gluteus medius, and gluteus minimus muscles, how would this be coded?
Answer: Five nerves were tested. Report code 95909 (for the now five to six NCSs), in addition to code 95886 (for the EMG). To clarify, if the tibialis posterior muscle was also tested, this would not change the EMG-code selection, as this still constitutes five or more muscles in one limb.

In your example, the median sensory nerve to the second digit and the median sensory nerve to the thumb would be considered to be two separate NCS. For sensory NCS, there is a total of 6 studies:
1. Right median to digit 2
2. Right ulnar to digit 5
3. Right sural sensory nerve
4. Right superficial peroneal sensory nerve
5. Right median to thumb
6. Right radial to thumb (this is a separate comparative study)​

and there are 4 motor NCS:
1. Right median to Abductor pollicis brevis (the listings of wrist and elbow just indicates testing at multiple sites along the median motor nerve to APB muscle)
2. Right Ulnar to Abductor digiti minimi
3. Right Peroneal to Extensor digitorum brevis
4. Right Tibial to Abductor hallucis​


For a total of 10 NCS or 95911 x 1
 
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