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95860 AND 95903

Ramona Posted Thu 10th of January, 2013 16:28:30 PM

Is there any information as to why CCI edit changed for the following codes 95860 and 95903, 95904. Prior to 10/1/12 95903, 95904 were allowed on the same day as 95860 with a 59 modifer. Also with the CPT code change for the NCS codes begining 2013 CCI edit is not allowing 95907 with 95860.

I am looking for explaination for my provider.

SuperCoder Answered Fri 11th of January, 2013 19:06:51 PM

Hi, this is latest from

AMA Symposium: Know What to Expect in Chemodenervation and NCS Changes for 2013

Here’s the latest news on implementation, straight from the AMA.

Watch Study Counts for Updated NCS Codes

Barkley also advised attendees to be careful when reporting nerve conduction tests in 2013.

"The codes have been restructured to reflect the total number of nerve conduction studies performed as the unit of service, rather than each nerve," he explained. "This will be very important when we report these codes moving forward."

Changes: Familiar test codes 95900-95904 were deleted from CPT® 2013 in favor of seven new options. Codes 95907-95913 (Nerve conduction studies …) each specify the number of studies represented by the code, from one to 13 or more.

"Remember each type of nerve conduction study is counted only once when multiple sites on the same nerve are tested," Berkley added. In addition, a single nerve conduction study includes all orthodromic and antidromic testing. Once you move to a different muscle or nerve or nerve branch, the diagnostic testing would be considered a separate nerve conduction study that can be counted.

Also: Two new codes for intraoperative neurophysiology monitoring are introduced in 2013. The new choices are:

+95940 -- Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
+95941 -- Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure).
The additions replace deleted code +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]). "There are two divergent styles of approach to performing intraoperative monitoring," Barkley explained. "The physician can either be in the OR in personal attendance during monitoring, or can monitor one or more case outside the OR by staying in communication with the OR team. Replacing +95920 with the new codes allows for differences in circumstances."

Make the Shift to Inclusive Provider Terminology

The most widespread changes throughout CPT® 2013 -- the switch to more inclusive or provider-neutral language -- shouldn’t be difficult for physicians or other providers to put into place.

"The concepts are pretty straightforward," said Richard Duszak, Jr., M.D., an AMA CPT® Editorial Panel member and practicing radiologist. "There’s been an evolution in CPT® for how codes report services by non-physicians."

Result: Hundreds of codes were revised for 2013 to include "provider neutral language." Codes throughout the book have replaced designations of "physician" with "individual" or "qualified health care professional."

presenter Gregory L. Barkley, M.D.

SuperCoder Answered Fri 11th of January, 2013 19:09:16 PM

The latest 2013 CCI Edits shows:

Code 95907 is a column 2 code for 95860, These codes cannot be billed together in any circumstances.
Code 95907 is bundled into code 95860 Code 95907 cannot be billed with 95860.

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