Opening the 2010 CPT® codebook for the first time last week, I was pleased to see the final publication of new code 95905. This new code will be used to report nerve conduction tests performed using preconfigured electrode arrays. Use of preconfigured arrays and highly automated devices has been a controversial issue between EDX specialists and primary care physicians for years. The AANEM and a number of other specialty societies spent long and difficult hours working to develop a coding solution that correctly describes this new and different service. The addition of 95905 appropriately distinguishes the new service from traditional NCSs.
Physicians who perform nerve conduction testing with preconfigured electrode arrays should now report code 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.” Parenthetical instructions further direct that, by definition, 95905 should be reported once per limb, and that 95905 should not be reported in conjunction with 95900-95904 or 95934-95936.
Physicians who perform nerve conduction testing with preconfigured electrode arrays should now report code 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.” Parenthetical instructions further direct that, by definition, 95905 should be reported once per limb, and that 95905 should not be reported in conjunction with 95900-95904 or 95934-95936.
Members are encouraged to share this coding memo with colleagues and coders to facilitate correct use of the new code. You can print, save, or link to the memo here.
10 comments:
its only controversial because you neurologist made it that way. Its nerve conduction period.....
Become a Real Doctor and you can join the club. Anyone can do an automated NCV. The only requirements are a breathing patient, an accessible limb and an expensive machine that needs to be paid for.
The first poster is an angry NeuroMetrix employee who just had their commissions slashed 90%.
I ask that same person who posted, if some in your family had a nerve related problem would you want your family doctor diagnosing you with an NC Stat or would you want them to see a neurologist/PMR?
Well...I am a neurologist. I suppose I could start taking out gall bladders. I sort of know how to do it. I can certainly read it in a book. It is the same thing with these conductions. I am tired of having to do the legitimate study and try to nevigate explaining to the patient why they are "paying twice" for a test...finding a completely different finding...AND trying not to tell the patient that their primary care (my referral base) ripped them off by trying to pass this testoff as a legitimate diagnostic test.
I am a neuro-tech working for the last 4 years. In my doctor's practice, we find it really painful to explain to the eldely patients that Medicare does not pay twice in the same year for the test when PCP has already done the test. Now their care is being delayed for almost 1 year because they are unable to pay for it now since they are in a limited income. I do not really see how a doctor (PCP) can knowingly interfere with the care of their own patients? When it comes to their own family member, would they just do the same test on their family member or would they rush them to their neurologist for the right diagnosis?
The NC-Stat is an FDA approved and reliable test which performs standard nerve conduction studies. The device has been on the market for several years and the company states they have performed well over a million patients with the machine.
We all know that neurologists are pissed off because they are losing potential revenue.
Why don't neurologists point out that the AAEM actually states that a needle EMG is just "an extension of the history and physical of the patient" and there are ZERO clinical studies that support EMG as valuable because it is subjective and varies depending on the neurologist performing. EMG is archaic and a huge money maker for neuros - period. NC-Stat does tradional NCV testing and have been widely studied showing accuracy when compared to a tradional test.
The elderly "in a limited income"? And is yours and mine "unlimited"?? Come on, as a group they are the wealthiest demographic in the country. Medicare = Wealth transfer.
In my practice (pain) I have never seen an EMG change what is offered a patient for their chronic pain. We have docs in town that have in their office: CT, EEG, sleep study, NCS/EMG, and then patient comes to me and I say "What did they do for your pain?" And they say "Nothing. They sent me to you."
NC Stat is a non-specific, generic nerve test.
I have been performing NCV's for 6 years with a neurologist who is fellowed in Neuromuscular disorders and have seen dozens of NC-stat tests that come back with a vague or non-specific diagnosis. And sometimes wrong diagnosis.
We performed a NCV/EMG on a woman who was referred for CTS. After performing NCV and EMG she was diagnosed with ALS(Lou Gehrig's disease). If she would have had NC-Stat she would have been misdiagnosed and missed out on several weeks of end of life planning, living and preparation for her 9 year old sons future without her.
It is for this reason NCV and EMG should always be performed together to ensure the patient gets a complete, accurate and thorough test.
In response to the poster who asked who I would want to evaluate my neuropathy I say that if its an entry level neuropathy like CTS, L5-S1 or diabetic peripheral neuropathy......i would have no problem with the NC Stat.
Its specificity and sensitivity are equivalent to a Cadwell or other device and the needle portion, which bring zero value, in these situations will make the test more palatable. Half the time a neuro does needles for no reason other than to boost revenue.
The conditions the NC Stat are valid for are simply everyday neuropathies. Maybe some Drs overuse where it shouldnt be used, but for the most part it provides the PCP with a accurate idea of mild, moderate or severe for neuropathies and helps to guide patient care. No waiting for weeks to get the neuro NCV with unnecessary components being performed.
Instead of being scared of it, neuros should embrace it where it fits. Its simply and advancement making testing easier and eliminating the technician. Talk about scared of change and advancement.....that despicable and neuros should be ashamed of themselves.....you probably still use an calculator the size of Texas to compenstate for skin temperature....oh, you probably dont even do that sorry.
In addition, the payment from Medicare for a motor nerve that includes 30 minutes of physician time should be considered fraud.....talk about a lobby......Ridiculous!
I agree with the last poster. I know neurologists & PM&R's that self refer for EMG/NCV studies and collect a ridiculous amount of money each month. Reimbursement at > $1000 per patient and doing 10-15 patients a day. It's almost fraud. There shouldn't be incentive to stick more needles and do multiple H-reflex, f-waves, or whatever else for creative billing. I think once these PM&R and Neurologists see the money maker this is for them, the adage Money Corrupts basically comes true... Honestly, I know a few pain management physicians that forces a 2 day schedule full of electrodiagnostics to collect an Obscene amount each month. It's quite sickening. Dare I say -> FRAUDULENT
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