Posted on 27. Mar, 2009 by in Hot Coding Topics
The AMA, modifier 59, and a highlighter can win NCS appeals.
You can kiss your “without F-wave serve conduction study (NCS)” pay good-bye unless you use these strategies to show the payer the additional study is separately payable. Take a look at this scenario one of our readers sent us and put your nerve conduction coding skills to the test.
Solve the Scenario
A patient arrives for neuromuscular electrodiagnostic testing on his lower extremity. Your neurologist performs a study that includes a distal and proximal Peroneal nerve conduction recorded off the extensor digitorum brevis (EDB) muscle, along the foot. The late-response F-wave study is also performed. How should this be billed?
Answer: Bill the NCS as 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study). So far, so good.
The plot thickens: The distal compound muscle action potential (CMAP) amplitude is below normal, so your neurologist performs an additional Peroneal conduction study, recorded off the tibialis anterior muscle (TA) stimulated at the fibular head. What code should you bill for this additional test?
Answer: Your instinct may be to bill 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), because the set-up and testing for the motor NCS to the TA muscle is different from the motor NCS with F-wave to the EDB muscle. This instinct is correct, but if Medicare or a private payer denies 95900, secure payment with the following ammo.
1: Back Up Your 95900 Claim With CPT
If facing this Medicare denial scenario, your first line of defense is the CPT 2009 manual. “Appendix J is helpful in illustrating that these two motor nerve conduction...
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