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Thread: Confussed

  1. #1

    Red face Confussed

    AAPC: Back to School

    Who can bill out for nerve conduction test? A physician or does it have to be a specialist?
    I have read some about how to bill for NCT but it confused me even more. It would be greatly appreciated if someone can explain how to code the following codes 95900, 95903,
    95904. Thank You

  2. #2


    Are you billing for a Neurologist??

  3. #3


    No. He is a Family Practice doctor but he also sees pts at a chiropractic office that is peforming the NCT.
    Last edited by dannielledarden@yahoo.com; 05-23-2011 at 03:39 PM.

  4. #4

    Exclamation Billing for NCT

    First, make sure you are familliar with the mark up rules for purchased diagnostic tests.

    You may ONLY purchase ONE component of the diagnostic test, either the professional (-26) or the technichal component (-TC).

    If the doc subs out both components, he cannot bill out the global service under Medicare rules.

    If your doc is providing the professional component for other physicians (when he goes into a chiro's office and performs the tests), which would mean he is interpreting the information and writting a report that is then submitted to the requesting doc, you would append the -26 modifier to the codes.

    But remember, 95900 and 95903 are reported as 1 unit for each nerve (even if it is performed at a different site on an extention of that same nerve).

    95900 is a NCT with F wave
    95903 is NCT without F wave

    Both of those codes test the "motor" component of a nerve.

    95904 tests the "sensory" component of the nerve.

    The AMA CPT Assistant states:
    "If nerve conduction studies are performed on two different nerves, the first with F-Wave study and the second nerve without F-Wave study, then the first nerve studied would be reported as 95903. Since the second nerve conduction study represents a separate distinct test, then CPT code 95900 may reported in addition to 95903."
    If 95900 is submitted with 95903--both reimburse separately...

    Also, the appropraite diagnosis codes (that are supported in the medical record) MUST accompany the billing.

    Every carrier has a slightly different list and rules that apply - so, billing, as ALWAYS depends on the carriers rules. Check them.
    Nerve conduction studies are used mainly for evaluation of paresthesias (numbness, tingling, burning) and/or weakness of the arms and legs. The type of study is determined by the problem.

    Here are a list of some common accepted ICD-9 codes for those tests:
    192.0 Malignant neoplasm of cranial nerves
    192.2 Malignant neoplasm of spinal cord
    192.3 Malignant neoplasm of spinal meninges
    225.1 Benign neoplasm of cranial nerves
    225.3 Benign neoplasm of spinal cord
    250.60 Diabetes with neurological manifestations; type II (non insulin dependent type) (NIDDM type)
    (adult-onset type) or unspec. type, not stated as uncontrolled
    250.61 ; type I (insulin dependent type) (IDDM type) (juvenile type) not stated as uncontrolled
    250.62 ; type II (non-insulin dependent type) (NIDDM type) (adult-onset type) or unspec. type,
    250.63 ; type I (insulin dependent type) (IDDM type) juvenile type), uncontrolled
    265.1 Other and unspec. manifestations of thiamine deficiency
    269.1 Deficiency of other vitamins (vitamin E, vitamin P)
    272.5 Lipoprotein deficiencies
    333.6 Idopathic torsion dystonia
    333.7 Symptomatic torsion dystonia
    333.81 - 333.89 Fragments of torsion dystonia
    334.1 Hereditary spastic paraplegia
    335.0 Werdnig-Hoffmann disease
    335.10 Spinal muscular atrophy, unspec.
    335.11 Kugelberg-Welander disease
    335.19 Other spinal muscular atrophy
    335.20 - 335.29 Motor neuron disease
    335.8 Other anterior horn cell diseases
    335.9 Anterior horn cell disease, unspec.
    336.0 - 336.9 Other diseases of spinal cord
    337.0 Idiopathic peripheral autonomic neuropathy
    337.1 Peripheral autonomic neuropathy in disorders classified elsewhere
    337.20 – 337.29 Reflex sympathetic dystrophy
    337.3 Autonomic dysreflexia
    337.9 Unspecified disorder of autonomic nervous system
    340 Multiple sclerosis
    341.0-341.9 Other demyelinating disease of central nervous system
    342.00 – 342.92 Hemiplegia and hemiparesis
    343.0 – 343.9 Infantile cerebral palsy
    344.00 – 344.09 Quadriplegia and quadriparesis
    344.1 Paraplegia
    344.2 Diplegia of upper limbs
    344.30 – 344.32 Monplegia of lower limb
    344.40 – 344.42 Monoplegia of upper limb
    344.5 Unspecified monoplegia
    344.60 Cauda equina syndrome, without mention of neurogenic bladder
    344.61 Cauda equina syndrome, with neurogenic bladder
    344.89 Other specified paralytic syndrome
    344.9 Paralysis, unspec.
    350.2 Atypical face pain
    351.0 Bell's palsy
    351.8 Other facial nerve disorder
    351.9 Facial nerve disorder, unspec.
    352.3 Disorders of pneumogastric (10th) nerve
    352.4 Disorders of accessory (11th) nerve
    352.5 Disorders of hypoglossal (12th) nerve
    352.6 Multiple cranial nerve palsies
    353.0 Brachial plexus lesions
    353.1 Lumbosacral plexus lesions
    353.2 Cervical root lesions, not elsewhere classified
    353.3 Thoracic root lesions, nec
    353.4 Lumbosacral root lesions, nec
    353.5 Neuralgic amyotrophy
    353.8 Other nerve root and plexus disorders
    353.9 Unspecified nerve root and plexus disorder
    354.0-354.9 Mononeuritis of upper limb and mononeuritis multiplex
    355.0-355.9 Mononeuritis of lower limb and unspec. Site
    356.0-356.9 Hereditary and idiopathic peripheral neuropathy
    357.0 Inflammatory and toxic neuropathy; acute infective polyneuritis
    357.1 ; polyneuropathy in collagen vascular disease
    357.2 ; polyneuropathy in diabetes
    357.3 ; polyneuropathy in malignant disease
    357.4 ; polyneuropathy in other diseases classified elsewhere
    357.5 ; alcoholic poluneuropathy
    357.6 ; polyneuropathy due to drugs
    357.7 ; polyneuropathy due to other toxic agents
    357.81 Chronic inflammatory demyelinating polyneuritis
    357.82 Critical illness polyneuropathy Acute motor neropathy
    357.89 Other inflammatory and toxic neuropathy
    358.00-358.01 Myasthenia gravis
    358.1 Myasthenia syndromes in diseases classified elsewhere
    358.2 Toxic myoneural disorders
    358.8 Other specified myoneural disorders
    358.9 Myoneural disorders, unspecified
    359.0 Muscular dystrophies and other myopathies; congenital heredity muscular dystrophy
    359.1 ; hereditary progressive muscular dystrophy
    359.2 ; myotonic disorders
    359.3 ; familial periodic paralysis
    359.4 ; toxic myopathy
    359.5 ; myopathy in endrocrine disease classified elsewhere
    359.6 ; symptomatic inflammatory myopathy in diseases classified elsewhere
    359.81 Critical illness myopathy
    Acute nectrotizing myopathy
    Acute quadriplegic myopathy
    Intensive care (ICU) myopathy
    Myopathy of critical illness
    359.89 Other myopathies
    359.9 Myopathy, unspecified
    376.82 Myopathy of extraocular muscles
    378.00-378.9 Strabismus and other disorders of binocular eye movement
    458.0 Orthostatic hypotension
    478.75 Laryngeal spasm
    564.6 Anal spasm
    710.3 Dermatomyositis
    710.4 Polymyositis
    710.5 Eosinophilia myalgia syndrome
    721.0 Cervical spondylosis without myelopathy
    721.1 Cervical spondylosis with myelopathy
    721.2 Thoracic spondylosis without myelopathy
    721.3 Lumbosacral spondylosis without myelopathy
    721.41 Spondylosis with myelopathy, thoracic region
    721.42 Spondylosis with myelopathy, lumbar region
    722.0-722.11 Displacement of cervical, thoracic, or lumbar intervertebral disc without myelopathy
    722.2 Displacement of intervertebral disc, site unspec. without myelopathy
    722.4 Degeneration of cervical intervertebral disc
    722.51 Degeneration of thoracic or thoracolumbar intervertebral disc
    722.52 Degeneration of lumbar or lumbosacral intervertebral disc
    722.6 Degeneration of intervertebral disc, site unspec.
    722.70-722.73 Intervertebral disc disorder with myelopathy
    722.80-722.83 Postlaminectomy syndrome
    722.91-722.93 Other specific disc disorder
    723.0 Spinal stenosis in cervical region
    723.4 Brachial neuritis or radiculitis NOS
    723.5 Torticollis, unspec.
    724.00-724.09 Spinal stenosis, other than cervical
    724.1 Pain in thoracic spine
    724.2 Lumbago
    724.3 Sciatica
    724.4 Thoracic of lumbosacral neuritis or radiculitis, unspec.
    724.5 Backache, unspec.
    728.0 Infective myositis
    728.85 Spasm of muscle
    728.87 Muscle weakness
    729.2 Neuralgia, neuritis and radiculitis, unspec.
    729.5 Pain in limb
    729.89 Other musculoskeletal symptoms referable to limbs
    736.05 Wrist drop (acquired)
    736.06 Claw hand (acquired)
    736.09 Other acquired deformities of forearm, excluding Fingers
    736.79 Other acquired deformities of ankle and foot
    781.4 Transient paralysis of limb
    781.7 Tetany
    782.0 Disturbance of skin sensation
    784.49 Other disturbance, including spasmodic dysphonia
    788.20 Retention of urine, unspecified
    788.21 Incomplete bladder emptying
    788.29 Other specified retention of urine
    788.31 Urge incontinence
    788.41 Urinary frequency
    952.00-952.09 Spinal cord injury without evidence of spinal bone injury, cervical
    952.10-952.19 Spinal cord injury without evidence of spinal bone injury, dorsal (thoracic)
    952.2 Lumbar spinal cord injury without evidence of spinal bone injury
    952.3 Sacral spinal cord injury without evidence of spinal bone injury
    952.4 Cauda equina spinal cord injury without evidence of spinal bone injury
    952.8 Multiple sites of spinal cord injury without evidence of spinal bone injury
    952.9 Unspecified site of spinal cord injury without evidence of spinal bone injury
    953.0-953.9 Injury to nerve roots and spinal plexus
    954.0-954.9 Injury to other nerve(s) of trunk, excluding shoulder and pelvic girdles
    955.0-955.9 Injury to peripheral nerve(s) of shoulder girdle and upper limb
    956.0-956.9 Injury to peripheral nerve(s) of pelvic girdle and lower limb
    957.0-957.9 Injury to other and unspecified nerves

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