New CPT® Header for NCS Codes

During discussion of how tests performed with preconfigured electrode arrays should be reported, the AANEM and others agreed it would be helpful to separately identify and define nerve conduction tests in the 2010 CPT® codebook.  A new header for "Nerve Conduction Tests" was added to complement the addition of 95905. Nerve conduction studies (NCSs) previously did not have their own introductory language.  The new header provides the following introductory information:

The following applies to nerve conduction tests (95900-95904): Codes 95900-95904 describe nerve conduction tests when performed with individually placed stimulating, recording, and ground electrodes. The stimulating, recording, and ground electrode placement and the test design must be individualized to the patient’s unique anatomy. Nerves tested must be limited to the specific nerves and conduction studies needed for the particular clinical question being investigated. The stimulating electrode must be placed directly over the nerve to be tested, and stimulation parameters properly adjusted to avoid stimulating other nerves or nerve branches. In most motor nerve conduction studies, and in some sensory nerve conduction studies, both proximal and distal stimulation will be used. Motor nerve conduction study recordings must be made from electrodes placed directly over the motor point of the specific muscle to be tested. Sensory nerve conduction study recordings must be made from electrodes placed directly over the specific nerve to be tested. Waveforms must be reviewed on site in real time, and the technique (stimulus site, recording site, ground site, filter settings) must be adjusted, as appropriate, as the test proceeds in order to minimize artifact, and to minimize the chances of unintended stimulation of adjacent nerves and the unintended recording from adjacent muscles or nerves. Reports must be prepared on site by the examiner, and consist of the work product of the interpretation of numerous test results, using well-established techniques to assess the amplitude, latency, and configuration of waveforms elicited by stimulation at each site of each nerve tested. This includes the calculation of nerve conduction velocities, sometimes including specialized F-wave indices, along with comparison to normal values, summarization of clinical and electrodiagnostic data, and physician or other qualified health care professional interpretation.

Code 95905 describes nerve conduction tests when performed with preconfigured electrodes customized to a specific anatomic site.

Addition of this comprehensive definition will help physicians, coders, and payors to determine the appropriate code to report physician work. This definition clarifies several important points. (1) Testing should be limited to those nerves necessary to address the clinical question being investigated; standardized, screening tests are not the same as carefully designed NCSs and do not entail the same physician work. (2) Waveforms must be reviewed on site. (3) Reports must be prepared on site.