Choosing the correct code for Nerve Conduction Studies (NCS)

Question:

When coding for nerve conduction tests, how are sensory, motor with or without F-wave, and H-reflex studies counted for nerve conduction tests?

Answer:

Nerve conduction studies are performed by placing electrodes directly over the motor point of the specific muscle to be tested and/or electrodes placed over the specific sensory nerve to be tested. H-reflex studies involve both the motor and sensory nerves and assess their connections in the spinal cord.

For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test (with or without an F wave test), or an H-reflex test.

Each type of study (sensory, motor, H reflex) for each nerve includes all impulses associated with that nerve and is counted as a distinct study when determining the number of studies billed.

Each type of study is counted only once when multiple sites on the same nerve are stimulated and recorded. The number of tests (sensory, motor, H reflex) per nerve should be added to determine the code to be billed.

CPT Appendix J contains a listing of motor and sensory nerves with each nerve counting as 1 unit of service.

*This response is based on the best information available as of 9/16/24.

Removal of Ventricular Catheter

Question:

What code would be used for removal of a ventricular catheter?

Answer:

There is no code for ventricular catheter removal, it is included in the placement as it is expected to be removed.

*This response is based on the best information available as of 7/11/24.

Arthrodesis Codes for Reporting Both Thoracic and Lumbar

Question:

Our neurosurgeon performed arthrodesis on a patient from T11 – L3 and we coded as 22612, 22610 and 22614 x2 and 22610 is being denied; can we add modifier 59?

Answer:

No; CPT codes 22610 and 22612 are both primary codes, and should not be reported together, if performed at the same operative session.  Correct reporting of an arthodesis that crosses a spinal junction, is reported  with one primary code and all other interspaces reported with the additional interspace code +22614.   

Select a primary code where most of the work is performed, in this case, lumbar.  So report 22612 as the sole primary code and 22614 x 3 for the additional interspaces. 

*This response is based on the best information available as of 6/20/24.

Billing an Extremity Angiogram with a Neuroendovascular Procedure

Question:

Our endovascular surgeons image the radial artery at the beginning of the procedure ( an initial run) to ensure that the artery is healthy/ in good shape to move forward with the procedure. They do not begin the actual procedure without ensuring the radial artery is normal. They also perform imaging as they complete the procedure (on the way out) to assess for any damage to the artery. Is this separately billable as 75710, imaging of a peripheral artery?

Answer:

Imaging of the access artery (radial or femoral) whether to assess patency of the access artery or as a completion study, checking to make sure no damage has been done to the access vessels is never billed separately.   Accessing a vessel is the approach for an endovascular procedures and is included in the primary procedure.  Furthermore, although not the primary reason for not billing, there is no pathology to support the medical necessity of  an extremity angiogram and that code requires imaging and documentation  of a full extremity study;  the entire arm,  not just a single peripheral vessel. 

*This response is based on the best information available as of 3/28/24.

Denials for Initial Hospital Care and Observation E/M Codes: 2024

Question:

We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital).  Are we doing something wrong?

Answer:

You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes.  Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing.  You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting. 

*This response is based on the best information available as of 3/14/24.

Modifiers with Unlisted Codes

Question:

Can I use modifiers on an unlisted code? 

Answer:

In some circumstances, a modifier may be appropriately appended to an unlisted code. 

For example,  

• CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes may be reported. If the two procedures are performed in the same anatomic region, then multiple units of the unlisted code may be reported with a modifier 59 

• Modifier 62 (two surgeons/co-surgery) may also be appended to an unlisted code such as 64999 if co-surgery is documented.  

• Modifier 58 for staged or more extensive procedures may also be appended to alert the payor to a second surgery during the global period, 

• During the global period, it may also be appropriate (and recommended) to append global period modifiers such as 78 or 79 to an unlisted code to fully describe the surgical scenario to a payor. 

Do not append modifier 50 (bilateral procedure), modifier 51 or modifier 52 or 53 to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22.

*This response is based on the best information available as of 2/29/24.