Wiki Semicolons

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kverduzco

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Our office is having a discussion on how to read a procedure code that has a semicolon in the main discription and then has two other codes under it.

Example
95900 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without
F-wave

95903 motor, with F-wave study
95904 sensory

doctor notes he did 1 nerve without F-wave, 2 nerves with F-waves and 1 sensory

I think it should be coded
95900 1
95903 2
95904 1

Several are under the impression that you cannot code the 95900 with the 95903 because the parent code is all inclusive. I was taught that it ends where the ; is and all three codes can be coded together.
 
parent codes are not all inclusive unless the guidelines spefically state so. the reason the semicolon is there is to save time and space in the book. otherwise they would have to type the whole description EVERY TIME. with indented codes and the semicolon, the part that is the same for each procedure only has to be typed once, with the differences spelled out after the semicolon next to each other code. think about all the shoulder and knee arthroscopy codes that are indented, can you imagine if every code had to have the whole description typed out completely? it would waste so much paper. now when billing NCV you do have to be careful with the motor nerves, as 95900 is included in 95903 when they are on the same nerve. however if they are on separate nerves you can bill separately, just be sure to use modifier -59 on 95900 to show it's a different anatomical location (different nerve), per NCCI. does that help? :)
 
I understand that 95900 is parent to the children codes. The nerves tested are different. He tested one nerve without F-wave (95900), 2 other nerves with F-wave (95903, 2 units) and still a different nerve sensory (95904). I'm a little confussed why the -59 goes on the parent code and not the two children codes. It seems to that even if just 1 nerve was being tested all three codes could be used because they are being tested 3 different ways. What am I missing?
 
it doesnt really have anything to do with how they are being tested, it's the type of nerve (motor or sensory) and how many are being tested. with motor nerves you need to know whether or not the F-wave test was done as well. the -59 goes on 95900 because it is a less extensive test (doesnt include the F-wave), and that's why 95900 was made a column 2 code by CMS. and you cant bill all three on one nerve because 1.) it's either a motor or sense/mixed nerve, cant be both, and 2.) there's the NCCI edit to deal with. you may know this already but the nerves that correspond to each test are located in appendix J, and they are broken up by nerve type, so motor NCV can only be billed on motor nerves, etc.
 
95900 is not a parent code maybe it would help to think of it this way:
Nerve conduction, amplitude and latency/velocity study, each nerve;
95900 motor, without F-wave
95903 motor, with F-wave study
95904 sensory
This is the way they are intending for this there is no parent code here they are all the same procedure just which type of nerve and motor nerves with or without F-wave. you really should not bill these with units you should bill a separate line item for each nerve and use the 59 such as
95900
95903
95903 59
95904
you can do the same nerve with f wave and without f wave. you cannot bill more than once per nerve so if you have multiple sites of the same nerve you can only bill one lline one unit.
 
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