CPT Code for Nerve Conduction Study: A Comprehensive Guide for 2023

CPT Code for Nerve Conduction Study

What is CPT Code for Nerve Conduction Study

A nerve conduction study (NCS) is a test that measures the function and speed of electrical signals in the nerves. It can help diagnose various nerve disorders, such as carpal tunnel syndrome, peripheral neuropathy, and Guillain-Barré syndrome. NCS involves stimulating a nerve with a small electric shock and recording the response from a muscle or a sensory receptor.

NCS is usually performed along with electromyography (EMG), which measures the electrical activity of muscles at rest and during contraction. EMG can provide additional information about the location and severity of nerve or muscle damage.

NCS and EMG are coded using Current Procedural Terminology (CPT) codes, which are standardized codes used to describe medical services and procedures. CPT codes are used by healthcare providers, insurance companies, and other entities to communicate and process claims for reimbursement.

In this article, we will explain how to code for NCS and EMG using the latest CPT codes for 2023. We will also provide some tips and guidelines on how to avoid common coding errors and ensure accurate billing and reimbursement.

CPT Codes for Nerve Conduction Study

The CPT codes for NCS are:

  • 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
  • 95907: 1-2 nerves
  • 95908: 3-4 nerves
  • 95909: 5-6 nerves
  • 95910: 7-8 nerves
  • 95911: 9-10 nerves
  • 95912: 11-12 nerves
  • 95913: 13 or more nerves

CPT defines a single conduction study as: “a sensory conduction test, a motor conduction test with or without an F wave test, or an H-reflex test.”

The number of nerves tested is determined by counting the number of distinct nerve conductions performed, regardless of the number of limbs or sites involved. For example, if a median nerve sensory conduction test is performed on both hands, it counts as one nerve. If a median nerve motor conduction test with an F wave is performed on both hands, it counts as two nerves.

The CPT codes for NCS are based on the number of nerves tested per session, not per limb. For example, if four nerves are tested on one limb and two nerves are tested on another limb in the same session, the appropriate code is 95908 (3-4 nerves), not 95907 (1-2 nerves) + 95909 (5-6 nerves).

The CPT codes for NCS include the interpretation and report of the test results. Therefore, separate codes for the professional component (modifier 26) or technical component (modifier TC) should not be used.

CPT Codes for EMG

The CPT codes for EMG are:

  • 95860: Needle electromyography; 1 extremity with or without related paraspinal areas
  • 95861: Needle electromyography; 2 extremities with or without related paraspinal areas
  • 95863: Needle electromyography; 3 extremities with or without related paraspinal areas
  • 95864: Needle electromyography; 4 extremities with or without related paraspinal areas
  • 95865: Needle electromyography; larynx
  • 95866: Needle electromyography; hemidiaphragm
  • 95867: Needle electromyography; cranial nerve supplied muscle(s), unilateral
  • 95868: Needle electromyography; cranial nerve supplied muscles, bilateral
  • 95869: Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12)
  • 95870: Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters
  • 95872: Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking, and/or fiber density, any/all sites of each muscle studied
  • 95873: Electrical stimulation for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)
  • 95874: Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)
  • 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 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 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 code for primary procedure)

CPT defines a muscle as: “an individual muscle or group of muscles innervated by a single nerve root or peripheral motor nerve.”

The number of muscles tested is determined by counting the number of distinct muscles or muscle groups examined, regardless of the number of needle insertions or sites involved. For example, if a biceps brachii muscle is examined on both arms, it counts as one muscle. If a biceps brachii and a triceps brachii muscle are examined on one arm, it counts as two muscles.

The CPT codes for EMG are based on the number of muscles tested per session, not per extremity. For example, if four muscles are tested on one extremity and two muscles are tested on another extremity in the same session, the appropriate code is 95864 (4 extremities), not 95860 (1 extremity) + 95861 (2 extremities).

The CPT codes for EMG include the interpretation and report of the test results. Therefore, separate codes for the professional component (modifier 26) or technical component (modifier TC) should not be used.

Tips and Guidelines for NCS and EMG Coding

The followings are some tips and guidelines to avoid common coding errors and ensure accurate billing and reimbursement for NCS and EMG:

  • Use the appropriate modifiers to indicate bilateral procedures (modifier 50), multiple procedures (modifier 51), or distinct procedural services (modifier 59) when applicable.
  • Use the appropriate diagnosis codes to support the medical necessity of the tests. Refer to the payer policies and guidelines for the accepted diagnosis codes for NCS and EMG.
  • Document the test results clearly and completely in the medical record. Include the number of nerves and muscles tested, the parameters measured, the interpretation and report of the findings, and the clinical correlation and impression.
  • Do not bill for NCS or EMG performed using automated devices (such as NC-stat System) with the current CPT codes. These devices do not support testing of other locations and nerves as needed, depending on the concurrent results of testing. Use HCPCS code G0255 instead.
  • Do not bill for NCS or EMG performed by unqualified or uncredentialed providers. Refer to the payer policies and guidelines for the qualifications and credentials required for performing these tests.
  • Do not bill for NCS or EMG performed for screening purposes or without a specific clinical indication. Refer to the payer policies and guidelines for the coverage criteria and limitations for these tests.

Conclusion

NCS and EMG are valuable tests to evaluate the function of the nerves and muscles, but they can be challenging to code correctly. By using the latest CPT codes for 2023, following the payer policies and guidelines, and documenting the test results thoroughly, you can avoid coding errors and ensure accurate billing and reimbursement for these services.

References

(1) Tips For Nerve Conduction Study Coding – Outsource Strategies International.
(2) Coding Electromyography (EMG) and Nerve Conduction Studies (NCS).
(3) Nerve Conduction study and EMG – Radiology billing, Coding.
(4) Article – Billing and Coding: Nerve Conduction Studies and ….

FAQs

Can NCS and EMG be performed together in the same session?

Yes, NCS and EMG can be performed together in the same session. However, it is important to use the appropriate CPT codes to accurately reflect the tests performed.

Are there any specific documentation requirements for NCS and EMG coding?

Yes, it is crucial to document the test results clearly and completely in the medical record. This includes the nerves or muscles tested, the findings, and any relevant interpretations or conclusions.

Can automated devices be used for NCS or EMG testing?

No, the current CPT codes for NCS and EMG do not cover testing performed using automated devices. Manual techniques and interpretation by qualified healthcare providers are required for accurate coding and billing.

Are there any restrictions on who can perform NCS and EMG tests?

Yes, NCS and EMG tests should be performed by qualified and credentialed healthcare providers with appropriate training and expertise in neurophysiology. It is important to ensure that the tests are conducted by professionals who meet the necessary qualifications.

Can NCS and EMG be billed for screening purposes or without a specific clinical indication?

No, NCS and EMG should be performed for diagnostic purposes based on a specific clinical indication. Billing for screening purposes or without a valid medical necessity is not appropriate.

What are the common conditions that may require NCS and EMG testing?

NCS and EMG testing is commonly used to diagnose conditions such as carpal tunnel syndrome, peripheral neuropathy, radiculopathy, myasthenia gravis, and muscular dystrophy, among others.

Are there any age restrictions for NCS and EMG testing?

NCS and EMG testing can be performed on individuals of any age, including children and older adults, depending on the clinical indications and the patient’s overall health status.

Do insurance providers typically cover NCS and EMG testing?

Coverage for NCS and EMG testing may vary depending on the insurance provider and specific policy. It is advisable to check with the insurance company beforehand to determine coverage and any pre-authorization requirements.

Are there any potential risks or complications associated with NCS and EMG testing?

NCS and EMG testing are generally safe procedures with minimal risks. Some individuals may experience a temporary discomfort or mild soreness at the electrode placement sites. Serious complications are rare.

Can NCS and EMG tests provide a definitive diagnosis for nerve and muscle disorders?

NCS and EMG tests provide valuable information for the diagnosis of nerve and muscle disorders, but they may not always provide a definitive diagnosis on their own. The test results are typically used in conjunction with clinical evaluations and other diagnostic tests to establish an accurate diagnosis.

CPT Code for Nerve Conduction Study: A Comprehensive Guide for 2023
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