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Recent Changes to Nerve Conduction Codes

 

We have been getting numerous questions on EMG/NCS as to how to count specific nerves or how to code NCS with correct CPT 2013 codes, why our EMG codes are getting denied when billed with NCS codes, etc etc.

This is an attempt to demystify all the coding and billing quandaries.

AMA made changes to NCS codes as of Jan 1st 2013 and the new codes 95907-95913 replaced the old CPT codes 95900, 95903 and 95904.

Per CPT 2013, a single conduction study is defined as a sensory conduction test, a motor conduction test w or w/o an f-wave or an H-Reflex test. Each type of study for each nerve includes all orthodromic and antidromic impulses associated with that nerve and hence considered a distinct study. It also states that each type of conduction study is counted only once when multiple sites on the same nerve are stimulated. So if the provider tested radial motor nerve to ECU(extensor carpi ulnaris) and to the EDC (extensor digitoris communis), this would be counted as one study. Hence the total number of tests should be added together to get the right code from 95907-95913. Also remember “only one code would be reported with a maximum of 1 unit of service that represents all the nerve conduction studies performed on that date”.

One such example would be if a physician performs a sensory study and motor study on ulnar nerve, than it would be counted as two studies. Remember the old codes were based on the number of nerves but the new codes are now based on the number of studies, so CPT 95907 would be used.

Another example: where a neurologist performs a median motor and sensory and radial motor and sensory, it would be counted as four studies and CPT 95908 should be reported.

Appendix J in the 2013 CPT book provides the maximum number of studies that can be performed for a particular indication.

Another frequently asked question is “are NCS codes primary codes to EMG codes (95885-95887) and the answer to this question is "Yes". The EMG codes are add-on codes and by definition, they must be reported with the primary base codes which are NCS codes. If the physician is performing EMG and NCS during the same encounter then CPT 95885-95887 should be billed with the new NCS codes 95907-95913. But if only EMG studies are being performed without NCS then the old codes 95860, 95861-95863, 95864-95870) should be used.

4 Best Practices for Collecting Out-of-Pocket Patient Fees

 

This is a guest post by Brittany Richards from Software Advice. In her post Brittany writes about best practices for collecting out-of-pocket patient fees.

One of the most important aspects of a medical practice’s success is collecting the money that a patient owes them. This seems like a “no-brainer,” right? Well that does not necessarily make it an easy feat. Patient out-of-pocket fees account for 30 percent of a practice’s revenue, yet once a patient walks out the door, chances of collecting that money are practically cut in half.

The bright side is that there are ways to improve the collections process in order to ensure payment efficiency. After speaking with practice management consultants, we found four strategies to improve patient fee collection while maintaining strong customer satisfaction.

1. Train Your Team

The office manager may handle claims, but the entire staff should still know insurance policies and procedures. A good way to do this is to train employees on their own benefits. That way they can see it from both perspectives.

Your staff should also be trained on how to ask for money from patients. Requesting payments can be tricky. A good method is to have a script of exactly what to say. For instance, instead of saying “you owe 30 dollars,” a staff member could ask “cash, check or charge?” This less confrontational approach lowers the chances of a patient being turned off.

2. Educate Your Patients

A patient should never be blind-sided by costs. It’s best to be as upfront as possible. This is particularly applicable for patients who have a high deductible or are self-pay. For these patients, try and talk with them before they arrive for their appointment. If your practice offers a discount for patients who pay large amounts on the spot, then discuss this opportunity with them before the time of payment. This makes patients more comfortable about paying a larger amount of the bill.

3. Automate the Collections Process

This is the 21st century. It’s time to accept credit cards. You pay a higher fee for credit card payments, but more patients are willing to pay this way. Ask your patients to keep their credit card information on file. With their permission, you can automate payments of an agreed upon amount.

Starting in January 2013, the Affordable Care Act will require practices to automate patient eligibility too. This should dramatically decrease issues in accounts receivable because patients will know their financial responsibility within 20 seconds.

4. Be Professional About Balances

In the age of information, there should be a record of everything. There should be something in writing for the sake of your practice and your patients. If you decide to accept installments on a balance, have the patient sign a promissory agreement. If you don’t keep it professional, they won’t either.

No matter which of these methods work best for you, be sure to keep the purpose of each one in mind. Communicate your expectations clearly to your staff and patients to make sure there’s an understanding on the how, when and what of out-of-pocket fees.

For more on the topic, drop by Software Advice’s website and check out the original post on the Profitable Practice blog.

 

How To Correctly Code New EMG Codes ?

 

In the past few days we received a lot of queries regarding EMG denials and new EMG codes so we decided to write a blog article on this topic.  Hope our readers will find it useful.

As of January 1st 2012, AMA has introduced 3 new EMG codes to be used in place of previous EMG codes (95860-95864, 95867-95870) when NCV (Nerve Conduction Velocity) testing and EMG are performed together on the same date of service on the same patient. It is very important to bill the claims correctly if EMG studies are performed the same day as nerve conduction studies otherwise the claims will be denied.

Here are the 3 new EMG codes:

  • 95885: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to the code for primary procedure).
  • 95886: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to the code for primary procedure).
  • 95887: Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study; (list separately in addition to the code for primary procedure).

Unlike the old EMG codes 95860-95864 where the code specify the number of limbs tested, the new EMG codes state "each extremity", therefore you may bill up to 4 units for either CPT 95885 or CPT 95886 depending upon the no. of muscles tested. Keep note of the word "limited" in CPT 95885 which means less than five muscles.

(Do not report 95885, 95886 in conjunction with 95860-95864, 95870, 95905 and CPT 95887 in conjunction with 95867-95870, 95905)

Lets take a look at one of the examples: A neurologist performs two limb EMG on five muscles along with a five motor NCV without F test and a two motor sensory NCV test, in that case the correct way to code this is:

       CPT 95900 (Motor NCV w/o F test)    5 units
       CPT 95904 (Sensory NCV)                2 units
       CPT 95886 (EMG complete study)     2 units

Remember the parenthetical language "(list separately in addition to the code for primary procedure)", this is a reminder that the primary codes ( NCVs) should be reported with these codes. However, if the physician performs only the EMG tests without any Nerve Conduction Studies on the same day then the old EMG codes (95860-95864 and 95867-95870) should be used.

For example:  A neurologist performed a one limb EMG (6 muscles) without any NCV on the same day. Because no NCVs were performed that day on that patient, the old Code 95860 ( Needle Electromyography; 1 extremity with or without related paraspinal areas) should be used.

For recent changes in Nerve Conduction Study Codes 2013, please visit our latest blog post

Recent Changes to Nerve Conduction Codes


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Posted by SMBS Team

Why CPT 95937 Should Not Be Used For Train of Four (TOF) Monitoring?

 

CPT 95937 (neuromuscular junction testing (repetitive stimulation, paired stimuli) each nerve, any one method) is used for Neuromuscular Junction Testing and should not be used for Train of Four (TOF) Monitoring.

Train of Four Testing

According to CPT guidelines, Neuromuscular Junction Testing is the stimulation of an individual motor nerve by means of repetitive electrical impulses with measurement of the resulting electrical activity of a muscle supplied by that nerve. According to the CPT Assistant April 2002 Volume 12, Issue 4, under Electrodiagnostic Medicine - “repetitive stimulation studies are used to identify and to differentiate disorders of the Neuromuscular Junction (NMJ). This test consists of recording muscle responses to a series of nerve stimuli (at variable rates), both before, and at various intervals after, exercise or transmission of high-frequency stimuli.” The physician uses sensors to measure and record the nerve functions such as amplitude and conduction.

Physicians often use NMJ to diagnose patients with fatigable weakness to evaluate for possible disease of the Neuromuscular Junction. These diseases may include myasthenia gravis or myasthenic syndromes as well as botulinum toxicity. Rarely, exposure to certain drugs such as aminoglycoside antibiotics or D-Penicillamine can potentiate myasthenic symptoms.

According to AANEM’s (American Association of Neuromuscular & Electrodiagnostic Medicine) recommended policy for Electrodiagnostic Medicine, NMJ testing is performed to test disorders like myasthenia gravis and myasthenic syndrome.

Also per CMS contractor, Novitas Solutions, Inc.,“Neuromuscular junction testing must not be billed for any diagnostic test or procedure that does not meet the CPT definition of code 95937 {neuromuscular junction testing (repetitive stimulation, paired stimuli) each nerve, any one method}.  Examples of tests or procedures not covered under this code of repetitive nerve stimulation include quantitative sensory testing by any means and sensory nerve conduction threshold testing. Tests depending on the patient’s subjective response to single or repetitive 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.”

Train of Four Testing does not fit the criteria set by CMS and Insurance Carriers for CPT 95937.

Hence it is inappropriate to bill Neuromuscular Junction Testing code for Train of Four Monitoring. There is no separate code for Train of Four Monitoring.

Just because others are using CPT 95937 for Train of Four Monitoring and getting reimbursed for this service does not mean that it is correct. Billing this code for other than what it is meant for may lead to audits.

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Posted by SMBS Team

How To Correctly Code Your EMG Studies To Maximize Your Reimbursement ?

 

Needle EMG is the recording and study of electrical activity of muscles using a needle electrode. Neurologists use EMGs to test the electrical activity of a skeletal muscle to provide a medical diagnosis on a patient. Although these are common procedures but coding them incorrectly can not only cause billing problems but often lead to audits.

The Centers for Medicare & Medicaid Services (CMS) outlines clearly its recommendations for EMG billing in the Federal Register (issue of October 31, 1997, Vol. 62, No. 211, page 59090), which covers some common questions like how many muscles should/need to be studied per limb in order to use the limb EMG codes or which code should be used when performing a limited study of a specific muscle and whether it can be used multiple times.

Here are some tips which can clarify EMG billing confusions and help in maximizing your EMG reimbursements:

1. When choosing an EMG code, count the limbs and identify the specific muscles the physician has tested. The first set of EMG CPT codes 95860-95864 are used on the basis of this analysis. To report these codes, the physician must evaluate extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal or femoral but not sub-branches) And a minimum of five muscles studied per limb.

For example: If a physician performs EMG test on a patient’s right leg and meets the minimum testing requirements (five muscles innervated by three nerves each), then he should report CPT 95860.

A single unit of 95860, 95861, 95863 or 95864 includes all muscles of five or more tested in a particular extremity(ies). In other words, one should report only a single unit of 95860-95864 per session: You cannot bill additional units for more than five muscles per extremity.

CPT 95865 is used for needle examination of the larynx and CPT 95866 is used for needle examination of the hemidiaphragm.

If fewer than five muscles are tested then CPT 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles or sphincters) should be used.

2. The next set of CPT codes are 95867-95868 which describes the EMG study of muscles supplied by the cranial nerve, either unilaterally or bilaterally. If the answer to your question is yes, then CPT 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) OR CPT 95868 (Needle electromyography; cranial nerve supplied muscles, bilateral) should be used depending upon the test performed by the physician.

For example: A physician monitors the RLN (Recurrent Laryngeal Nerve) during a total thyroidectomy, he should assign the CPT 95868 for a bilateral EMG.

It is important to note that Codes 95867 and 95868 should not be reported together, nor should modifier -50 (bilateral procedure) be attached to CPT 95868.

3. Are studies performed on thoracic paraspinals other then those at T1 and T2? Then one must report CPT 95869 (Needle electromyography; thoracic paraspinal muscles).

Code 95869 is exclusively used to study thoracic paraspinal muscles between T3 and T11. One unit can be billed, despite the number of levels studied or whether unilateral or bilateral. 95869 cannot be reported with 95860-95864 if only the T1 and/or T2 levels are studied with an upper extremity. This code should be used if the examinations are confined to distal muscles only, such as intrinsic foot or hand muscles.

4. Is the study performed on fewer than five muscles per extremity, then CPT 95870 should be used. This code should only be used when the muscles tested do not fit more appropriately under any other CPT code. Code 95870 can be billed at one unit per extremity (one limb, arm or leg), when fewer than five muscles are examined.

For example: If a physician tests 3 muscles on the right arm and 4 muscles on the left arm, then code 95870 can be reported twice.

This code can also be used for examining non-limb (axial) muscles (e.g. intercostal, abdominal wall, cervical and lumbar paraspinal muscles (unilateral or bilateral)) regardless of the number of level tested. However, it should not be billed when the paraspinal muscles corresponding to extremity are tested, and when the extremity codes 95860, 95861, 95863, or 95864 are reported.

5. The last in row is code 95872 which is (Needle electromyography using single
fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied). This code should be used when a physician studies the action potentials (APs) from individual muscle fibers.

One should report one unit of 95872 for each muscle the physician tests. The physician will generally test at least two muscles (one test serves as a “control”), so you will report a minimum of two units of service. When  reporting CPT 95872, the physician must document the muscle(s) tested and the test results.

Keep these tips handy when coding and billing EMG studies. As always, please consult your payer guidelines and state regulations for any specific rules.

For recent changes in Nerve Conduction Study Codes 2013, please visit our latest blog post

Recent Changes to Nerve Conduction Codes

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Posted by SMBS Team

Key to Getting Maximum Reimbursement For Your Intraoperative Neuromonitoring Procedures

 

The key to getting maximum reimbursement for your IONM procedures is to keep yourself upKey to Getting Maximum Reimbursement to date with the payers clinical guidelines. Each individual carrier publishes the policies which outlines the rules and regulations regarding the use of a particular CPT, its limitations of coverage and/or medical necessity of that procedure.

It is amazing to see how one payer will pay for neurophysiological services for a spinal surgery due to disc degeneration while others may deny it stating not medically necessary. Not knowing the payer specific guidelines could mean a dip in your reimbursements. These guidelines issued by the payers not only defines the policies of IONM but they also outline the documentation requirements for such procedures necessary for reimbursements.

Not all policies are the same for all the carriers and not all the carriers have policies regarding every CPT code in the CPT manual. While most commercial carriers may have similar or identical policies but it should not be assumed that they are always the same. Even Medicare policies differ from state to state based on the CMS contractors. So it is always a good idea to check for LCD (Local Coverage Determination) defining the policies for IONM in your state. Here are some examples of how guidlelines differes from carriers to carriers and state to state  -

Recently Highmark BlueShield of Pennsylvania issued their IONM policy effective January 1st 2012, which is significant to the point where they have stated that "Intraoperative neurophysiology monitoring should be reported under procedure code 95920, regardless of the specific monitoring performed (e.g., brainstem auditory evoked response,
somatosensory evoked potentials, etc.). If any of the testing codes for neurophysiological
monitoring which are addressed below in the "Description" area of this policy are reported
in conjunction with 95920, the services should be combined and processed under 95920
(e.g., 95925 + 95920 = 95920)." This is a substantial change because this means that you can no longer bill SSEPS and MEPS on your claim and that means your receivables are going to get a hit.

On the other hand, payers like Aetna, Cigna, IBX etc. states that baseline study is separate and distinct from the intraoperative monitoring and each procedure can be reported separately.

In another example: CMS contractor Trailblazer (CO, NM, OK, TX) has different guidelines for billing IONM services. According to LCD 2924, this LCD imposes utilization guidelines limitations which is " Bill only for physician time. Bill each minute of the physician’s time once. If multiple patients are monitored simultaneously, bill with CPT code 95999".

Whereas CMS contractor like NAS (Noridian Administrative Services, LLC) for Arizona describes in their LCD "Intraoperative neurophysiological testing (CPT code 95920) is an add-on code to be filed in addition to the primary procedure(s), e.g., SEP (CPT codes 92585, 92586, 95925, 95926, 95927, 95928, 95929,95930). The primary procedure(s) covers the usual test time of 30-60 minutes. Providers may bill one unit for 95920 for each additional 60 minutes of monitoring beyond what is covered for the primary procedure".

In another example: Blue Cross and Blue Shield of Alabama considers Intraoperative Neurophysiologic Monitoring which includes SSEPs, BAEPs, EMG of cranial nerves, EEG, motor evoked potentilas using Transcranial electrical stimulation and ECog to be medically necessary during fracture of spine, scoliosis, spial stenosis, spondylolisthesis or spondylosis, carotid endarterectomy etc. For the complete description of the conditions please refer to policy no. 306.

Whereas Novitas Solutions which serves as the Part B Medicare Administrative Contractor (MAC) for Jurisdiction 12 (J12), which includes Delaware, New Jersey, Pennsylvania, Maryland, the District of Columbia and the counties of Arlington and Fairfax in Virginia and the City of Alexandria in Virginia, in their LCD L27499 imposes ICD-9 limitations that support diagnosis to procedure code. For example spinal stenosis, disc degenerative diseases, spondylosis, Postlaminectomy Syndrome, Compression Fractures etc. are not considered medically necessary. For complete coverage of the policy please refer to LCD L27499.

As one can note from above examples that policies vary from carrier to carrier and to reduce denials one should stay abreast of such policy changes. It is very important to verify each payer's policies and especially when there is a denial to see if the denial is valid. Monitor these policies frequently as payers update them on a regular basis. If a denial is not justified, support your appeal with the copy of the clinical guidelines. Be sure your practice is up to the speed with these revisions to ensure proper insurance reimbursements and reduced claims denials.

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Posted by SMBS Team

Changes in Intraoperative Neuromonitoring CPT codes and their Effect on Insurance Reimbursements

 

Have you seen a decline in your Intraoperative Neuromonitoring insurance reimbursements lately? Are you seeing more and more payersdecline in IONM reimbursements denying your claims stating procedure was not medically necessary or procedure was experimental. Ever thought why -

The answer to you question is changes in the medical policies and guidelines. Every Payer has their own clinical policies and they keep revising it from time to time. Recently AMA (American Medical Association) stated, beginning January 1st 2012, Codes for SSEPs Upper and Lower limbs and MEPs Upper and Lower Limbs are combined, so instead of CPT 95925 (somatosensory evoked potential;Upper Limbs) and CPT 95926 (somatosensory evoked potential ;Lower Limbs) CPT 95938 should be used if SSEPs are performed in both upper and lower limbs (Do not report 95938 in conjunction with 95925, 95926). Similarly CPT 95939 should be used for Motor Evoked Potential studies performed in both upper and lower limbs (Do not report 95939 in conjunction with 95928, 95929).

With these changes, some of the carriers have also changed or revised their clinical policies like Aetna where in they no longer are going to cover intraoperative SSEPs for certain procedures like implantation of spinal cord stimulator, hip replacement surgery, thyroid and parathyroid surgery etc. Aetna also considers intra-operative EMG monitoring during spinal surgery experimental and investigational due to insufficient evidence that this technique provides useful information to the surgeon in terms of assessing the adequacy of nerve root decompression, detecting nerve root irritation, or improving the reliability of placement of pedicle screws at the time of surgery.

On the other hand payers like Medicare does not pay for Intraoperative Neuromonitoring CPT code 95920 for conditions like Stenosis, Radiculopathy, Degenerative disk diseases, Disc displacement without Myelopathy and Spondylosis without Myelopathy.

Now the question is how do you combat with such denials? Here are some steps you should take into consideration:

  • Review the clinical policies and verify that the denial is justified.
  • Experimental and/or investigational procedures may be covered if you justify it with the letter of medical necessity. Submit all the accompanying medical notes and explain why the procedure was requested and performed. Any clinical journals or articles included will a huge plus.
  • Also note that your POS (place of service) should be marked correctly on the claim. You wll be surprised that payers like Medicare will deny the claims as not medically necessary if your POS is incorrect. Most of the claims that involve hospital stays lasting less than 1 day will trigger the denial. Medicare considers IONM services to be medically necessary only in an inpatient setting.

Also be very diligent when billing Workers Comp Carriers with these new CPT codes. Review the State specific fee schedule to make sure that these new CPT codes are included in the State Workers Comp fee schedule. Chances are that state may not have revised their fee schedule and if you bill your claims with new CPT codes your claims are going to get denied. For example: State of CA does not recognize CPT 95938 and CPT 95939. If in doubt, call the payer for their clinical guidelines or check on their website to have the latest information.

Another important point to note with recent changes in SSEPs and MEPs CPT codes are that 95938 and 95939 are not listed as primary procedures for CPT 95920. Not sure if this is just an oversight by AMA and if they are going to have an ERRATA but this means that if you are billing just the SSEPs Upper and Lower limbs along with CPT 95920, be prepared to write appeal letters if your claim gets denied because CPT 95920 is an add on code and not a stand alone code.

Be sure your practice is up to the speed with these revisions to ensure proper insurance reimbursements and reduced claims denials.

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Posted by SMBS Team

An Introduction to Mac-based Medical Billing Applications

 
A piece on medical billing software from Software Advice caught my attention. I wanted to share it with my readers - I thought you might find it useful.

Katie Matlack, the medical software writer for Software Advice, noted that with the rise in popularity of iPhones and iPads, many doctors are looking for the same simplicity and convenience in the computer products they use at work. She also made the point that one area in which doctors are always looking to improve is in medical billing. From there, she went on to discuss options that folks with Mac systems have and provided some medical billing software reviews.

Here’s a quick overview:

There are several things to keep in mind when you are exploring what Mac-compatible medical billing software to get.
  • Can the software support a practice of your size?
  • Is your software appropriate for the specialty your practice serves?
  • Do you want to purchase a web-based solution (also known as a hosted or software-as-a-service option – or a traditional Mac-based software system that’s installed on-site at your office)?

That last point can often make people take a step back and wonder what is the difference between web-based solutions and native-based solutions. Fortunately, Katie talks about the differences in her post, pointing out that web-based solutions are the norm for Mac users in the medical world because the vast majority of medical practices are still based on personal computers (PCs) that run Windows (and so there are very few software solutions built specifically for the Mac). However, she also makes the point that, for offices that run entirely on Apple computers and are looking for a consistent Apple OS look and feel, finding a native Mac solution can be the preferred choice.

Katie includes a list of medical billing software options, covering both native Mac solutions as well as web based ones. Head on over to her blog post for a more detailed discussion of how to choose the right medical billing software for your Mac-based office.  

Posted by Simant Ajmera

How To Correctly Bill Nerve Conduction Studies?

 

A nerve conduction study (NCS) is a neurological test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and Nerve Conduction Study resized 600sensory nerves of the human body. The nerve conduction test provides physicians with information about the functioning of the peripheral nerves including both the type of dysfunction and the likely location of its cause. It is used to help diagnose various diseases that impact the nerves.

Coding and billing these procedures incorrectly could lead to a significant loss in reimbursement. Understanding these codes help gain in proper reimbursement.

The Nerve Conduction Studies include following codes:   

95900: Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study
95903:Nerve conduction, amplitude and latency/velocity study, each nerve; motor,with F-Wave study
95904:Nerve conduction, amplitude and latency/velocity study, each nerve; Sensory
95905:Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report

By definition, CPT 95900 is bundled into CPT 95903 when it is performed on the same motor nerve. However, when multiple nerve conduction studies, with or without F Wave study are conducted on different motor nerves during the same session, they are billable using modifier 59 (Distinct Procedural Service) to indicate that a separate, distinct motor nerve was studied. But if multiples sites on the same nerves are stimulated or recorded then these codes are reported just once.

For example: If a physiatrist performs a test on 3 nerves without F-wave and the same 3 nerves are tested with F-wave, only CPT 95903 is reported X number of nerves. However, if the physiatrist performs motor study on 2 nerves in left arm and 2 sensory nerves in the right arm, then both CPT 95900 and CPT 95904 are reportable. If NCS is performed on two different branches of a given motor or sensory nerve, then again appropriate CPT from 95900-95904 series is reported.

There is however a unit limit on the codes. Codes 95900 and 95904 are listed as exclusions to the 3 unit limit and upto 12 units for CPT 95900 and CPT 95904 can be billed and upto 3 units for CPT 95903 can be billed.

For NCS performed with preconfigured electrodes array(s), CPT 95905 should be reported.

Codes 95900-95904 are modifier-51 exempt, so modifier-51(multiple procedure) should not be reported on these codes.

Documentation for Nerve Conduction Studies is very critical. NCS uses sensors to measure and record nerve functions including conduction, amplitude, and latency/velocity. Per AMA (American Medical Association), Nerve Condution studies are only billable if the provider documents the distance between the stimulation and recording sites, conduction velocity, latency values, amplitude and the nerves studied.

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Posted by SMBS Team

Understanding Burn Codes Just Made Easy

 

According to the ICD-9 CM officical guidelines for coding and reporting, burns are classified by depth, extent and by agent (E code). So before you assign a diagnosis code, here are a few things to remember.

  • Location/anatomic site of the burn
  • Extent/severity of the burn
  • Percentage of the body surface burnt
  • Cause of the burn

Severity of the burn is determined by burned surface and the depth of the burn and this comes from the 941-946 series. Burn Burn Codesdepths are classified in three degrees: first is superficial burns (inflammed and painful) involving the epidermis. These include erythema or redness of the skin; second degree invloves the middle layer i.e. dermal. These burns include blisters; third degree invloves full thickness skin loss. These are serious burns invloving all the layers of the skin including the fatty tissue beneath them.

Always sequence the first code that reflects the highest degree of burn (if more than one burn is present).

For example: A 25 yr old presents with a second degree burn of the right forearm and first degree burn of the right index finger and third degree burn of the abdomen. You must sequence your codes as 942.33 (3rd degree burn of the abdomen), 943.21 (2nd degree burn of the forearm), 944.11(1st degree burn of the index finger).

Imp:You should only code for the highest level burn when you assign multiple burns of differing degrees (severity) in the same body area.

Next you need to assign the code that reflects the extent of the burn i.e. how much body surface area is involved and this code comes from the 948 category. The inclusion of codes from 948 series is important as it may affect your reimbursement. To assign a code from 948 series simply ask what percentage of the body has been burnt and what percentage of the body has received 3rd degree burns.

For example: A patient presents with a 10% body surface with third degree burn of the thigh, assign code 948.11. Here the fourth digit of the code indicates the total percentage of the body that has been burnt and the fifth digit indicates the percentage of the body that has received third degree burns.

Lastly you need to assign the E code. E codes suggests as how the burns occured, whether it was accidental or caused by a hot substance or objects. If the burn is accidental, report an E code from E890-E899 (accidents caused by fire and flames) and if occured from hot objects report the code from E924 (accidents caused by hot substance or objects, caustic or corrosive material and steam).

For example: accidental steam burn in factory should be reported as E924.0 (burn by steam), E849.3 (Industrial place and premises).

Case Study: A 24 yr old youngman presents with a third degree burn on the right forearm 2%; first degre burn on right wrist 3%; and second degree burn to the right chest wall 5%. He states that he got burnt by hot steam while working in a restaurant.

Here's how the Codes should be sequenced:

943.31 (3rd degree burn forearm);

942.22 (2nd degree burn chest wall);

944.17 ( 1st degree burn wrist);

948.11 (Percent TBSA - indicates the percentage of body surface with 3rd degree burns);

E924.8 (accidents caused by hot substance or object, caustic or corrosive material & steam)

E849.6 (accident caused in Public building- restaurant).

Posted by SMBS Team

 

 

accidental burns from hot objects.
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