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.

Polydactyly Excision

Question:

We have a new surgeon in our practice who does hand surgery. I usually don’t code for hand surgery and have never coded a case before for polydactyly excision; how does one code this procedure? The documentation does not reflect any bony work.

Answer:

Within the hand section of the CPT book, you will find CPT code 26587. This code is for the reconstruction of polydactylous digit, soft tissue, and bone. Below this, there is a parenthetical note that states that for excision of polydactylous digit, soft tissue, only use CPT 11200. The documentation within the note will lead you to the appropriate code to report. Based on your scenario presented, CPT 11200 is applicable.

*This response is based on the best information available as of 9/11/24.

E/M service with treatment of Psoriasis

Question:

A new patient came in with an itchy scalp and came into my office today with a flare-up of her psoriasis.  Her psoriasis was diagnosed by another physician about 6 months ago. The psoriasis is worsening in her hand, but her scalp is fairly clear.  She has been using over-the-counter medication, which has not helped.  After a lengthy discussion about her condition, we decided a steroid injection on her palm would be beneficial since her entire palm was covered with scaly patches. I performed an injection on her hand and reported 11900 (intralesional injection).  I also wrote her a prescription for a topical ointment and scalp oil to use when needed.  We also discussed light box treatment, but she wants to try a topical prescription.  My question is can I bill an E/M service with the procedure?  One of my other colleagues told me I could not.

Answer:

Since you are doing more than the evaluation for the injection (11900), yes, you can bill an E/M service.  There is an inherent E/M service included in every procedure, but you counseled the patient, offered alternative treatment options, and prescribed prescription drug medications to the patient.  In this instance, the service does qualify for a significant separately identifiable E/M service with Modifier 25.  Based on the complexity of the problem addressed, which is chronic and not at treatment goal, and you prescribed prescription drug medication, you should report CPT codes 99204-25, 11901 and the J code for the medication injected.

*This response is based on the best information available as of 9/11/24.

Lower extremity revascularization

Question:

When coding lower extremity re-vascularization procedures, can the tibial-peroneal trunk, posterior tibial and anterior tibial arteries all be coded separately? 

Answer:

The tibial peroneal trunk (TPT) splits into the peroneal and posterior tibial (PT) arteries. The anterior tibial artery branches off the popliteal artery above the tibial peroneal trunk.  Therefore, when coding, the anterior tibial artery is considered separate from the TPT; however, the PT is considered a continuation of the TPT and not a separately coded vessel. So, if the anterior tibial, the posterior tibial, and the peroneal arteries are all treated, for example, with atherectomy, each may be separately reported.

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

Splanchnic Nerve Injection

Question:

We are unsure what CPT code to use when our physician injects the splanchnic nerve with phenol. Is this an unlisted CPT code? 

Answer:

Since the splanchnic nerve is part of the celiac plexus, and phenol is a neurolytic agent, you should report CPT code 64680, Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring. (For an injection of other substances such as an anesthetic and/or steroid, not a neurolytic agent, use code 64530 Injection, celiac plexus).

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

Fall Risk Prevention Program: Part 1

Question:

We want to institute a Fall Risk Prevention Program in our practice to take advantage of CMS's Merit-based Incentive Payment System (MIPS). Based on CMS’s 2024 Quality Measures List, what codes should we report, and can our practice's medical assistant (MA) capture this work? 

Answer:

It is great that your practice will institute a Fall Risk Prevention Program to capture MIPS. According to CMS’s 2024 Quality Measures list, are 2 measures reportable in this category. 

Quality measure number 155 - Falls: Plan of Care.  This measure is designed to capture the percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months. 

Quality measure number 318 – Falls: Screening for Future Fall Risk.  This measure is designed to capture the percentage of patients 65 years of age and older screened for future fall risk during the measurement period. 

Per CPT, these quality measures should be reported with Category II tracking codes, which are used for performance measurement. 

The applicable category II CPT codes for these MIPS measures are as follows: 

1100F: Patient screened for future fall risk; documentation of 2 or more falls in the past year or any fall with injury in the past year (GER). 

1101F: Patient screened for future fall risk; documentation of no falls in the past year or only 1 fall without injury in the past year (GER). 

An MA can capture the work to assist the clinician when reporting these Category II CPT codes. 

*This response is based on the best information available as of 9/5/24.