pf-NCS documentation

naptime7k@aol.com

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Pt Jefferson Station, NY
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I am looking for any documentation from AMA or AASEM, or anyone, regarding the proper documentation and requirements of pf-Ncs testing. I have so many chiropractors overusing and I can't prove it. I always though CPT code 95904 required all components mentioned in the description to be correctly identified, but someone is telling me that's not true.

Providers use 95999 to report pf-NCS, but report 18 or 16 units for each nerve tested. I have been using 0110T as a relatively consistent code to reference for this service and unlisted code, which also changes the unit options to "how many extremities tested". Also, since WC does not have a RVU for this code either, I have used 95904 RVU as a reference for reimbursement.

Is this correct? Or can the provider simply go straight to 95904 and report by nerve. I also do not have medical records, simply working off denials.

Any ideas? Thanks
 
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Westbury, NY
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In multiple NY no fault arbitrations, the relative value of CPT code 95904 has been accepted as a suitable comparison code to be used per extremity. In the coding reviews that I do, I prefer to use the EMG as a comparison code, since the EMG is billed per extremity and not per nerve and the work value of the EMG is probably greater than sensation testing. The CPT code of 95904 will now be a problem since it is no longer in use in NY no fault and has been replaced by the series of codes 95907-95913, making it more difficult to use as a comparison. And finally, CPT code 0110T, which is the correct code for pfNCS testing, can no longer be billed by the chiropractor as per the 34th amendment.
 
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