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Thread: 95937

  1. #1

    Default 95937

    Can someone please give me guidelines on how to properly bill for 95937 during a spinal surgical procedure? How many units are allowable, etc. Does anyone have a full description as well from CPT Assistant?

  2. #2

    Default Code 95937

    Indications and Limitations of Coverage and/or Medical Necessity [/U]
    Indications
    Neuromuscular junction testing by repetitive stimulation may be reasonable and necessary to diagnose patients with known or suspected disorders of the neuromuscular junction. These include myasthenic syndromes such as myasthenia gravis and Lambert Eaton myasthenic syndrome (LEMS), as well as botulinum toxicity. Rarely, certain drugs such as aminoglycoside antibiotics can potentiate myasthenic symptoms.

    Limitations

    1. Neuromuscular junction testing by repetitive stimulation is not
    considered reasonable necessary for indications other than those
    listed above.

    2. Neuromuscular junction testing (CPT 95937) must not be billed for any
    diagnostic test or procedure that does not meet the CPT definition of
    CPT 95937. Examples include quantitative sensory testing by any means
    and sensory nerve conduction threshold testing. Tests depending on the
    patient's subjective response to stimulation (electrical, vibratory,
    thermal or tactile), regardless of whether or not these data are
    analyzed and presented through electronic or computerized systems,
    also fail to satisfy the definition of CPT 95937.

    NOTE: Quantitative Sensory Testing (QST) uses electrical or mechanical
    stimuli at varying amplitudes to evoke patients' subjective responses.
    Such tests are designed to be helpful in characterizing various types
    and degrees of neural damage or impairment. However, the clinical
    usefulness of such tests remains unclear. One such device is Current
    Perception Threshold/Sensory Nerve Conduction Threshold test
    (CPT/sNCT). CMS has determined that this test is not covered since
    there is insufficient scientific or clinical evidence to consider this
    device as reasonable and necessary within the meaning of
    §1862(a)(1)(A) of the Social Security Act. (See Medicare Coverage
    Issues Manual 50-57). Another such device is the pressure-specified
    sensory device (PSSD), which relies on a pressure stimulus to
    determine a sensory threshold. It is not appropriate to bill for QST,
    including PSSD, under CPT 95937 or any of the following CPT codes:
    95900, 95903, 95904, 95921, 95922, 95923, 95925, 95926, 95927.

    3. Neuromuscular junction testing by repetitive stimulation is not
    considered reasonable and necessary for the diagnosis or treatment of
    diabetic neuropathy.

    4. Neuromuscular junction testing by repetitive stimulation is not
    considered reasonable and necessary for the diagnosis or treatment of
    carpal or tarsal tunnel syndrome.

    5. Neuromuscular junction testing by repetitive stimulation is indicated
    for specific physical signs and symptoms (e.g. diplopia, weakness,
    dysphagia) only if there is actual clinical suspicion that a
    neuromuscular junction disorder is the cause.
    Coding Guidelines


    1. Generally the interpretation or cognitive performance of the test is
    considered part of the test and not an E&M service. An E&M service
    performed on the same date must be a separate and distinct service &
    must be reported with the modifier 25.

    2. Use modifier TC when reporting the technical component of 95937. The
    technical component is payable in office (11), skilled nursing
    facility (SNF) (31) only for patients whose Part A benefits have been
    exhausted, and independent clinic (49).

    Use modifier 26 when reporting the professional component of 95937.
    The professional component is payable in office (11), inpatient
    hospital (21), outpatient hospital (22), emergency room (23), skilled
    nursing facility (SNF) (31) only for patients whose Part A benefits
    have been exhausted, independent clinic (49), comprehensive inpatient
    rehabilitation facility (61), comprehensive outpatient rehabilitation
    facility (62) and ESRD treatment facility (65).

    3. Report code 95937 without a modifier if the global service is being
    performed. The global service may be billed in office (11), skilled
    nursing facility (SNF) (31) only for patients whose Part A benefits
    have been exhausted, or independent clinic (49).

    Hope this helps.
    Dr. Poonam

  3. #3

    Default

    Thank you Dr. Poonam,
    A Nuvasive representative told me that when I bill this during spinal surgery I should bill by however many screws are tested. Meaning if 8 screws were tested, I would bill 8 units of 95937. Do you happen to know if there is a limitation on how many units to bill and if this is an accurate way to bill. I would think you would bill by levels, not screws..?

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