The NC-stat system measures conventional nerve conduction parameters using standard instrumentation. All procedures performed using the NC-stat are identified using the established CPT™ codes listed on the right.

Coding Multiple Nerves:
Units are used to indicate the number of nerves tested when coding nerve conduction studies. When performed with the NC-stat, a motor study with F-wave of two separate nerves might be described as 2 units of 95903.

Some payers have specific requirements for modifiers. For example, certain payers will require a specific local modifier to indicate billing for multiple nerves and, if not used, will reimburse for one nerve/unit of the procedure.

Although nerve conduction CPT codes are designed to be billed per nerve by definition (no modifier needed), payers might not recognize this and reject them on a regular basis. A CMS 2000 OCI edit update suggested that the ‘-59’ modifier be used with with CPT code to indicate it is a “distinct procedural service” being performed on a different area of the body (different nerve). It is good practice to regularly cross reference units billed with reimbursement received.

Coding Components:
Nerve conduction studies consist of:

Professional component, the amount paid for the physician’s interpretation of the results of the study and associated overhead, and a
Technical component, the amount paid for all other services (including technician and equipment costs).

The global procedure describes both the professional and technical components. Most payers will process and reimburse for the global (entire) procedure, when nerve conduction studies are billed without modifiers indicating the separate components (TC or -26 modifier).

Please note that some payers have specific requirements for modifiers. For example, certain payers require a local modifier to indicate billing for the entire procedure and, if not used, will reimburse for one component of the procedure.

Nerve Conduction Policy:
CMS and other payers reimburse for medically appropriate nerve conduction studies. Most Medicare carriers have established lists of pertinent ICD-9 codes, which indicate medical necessity for nerve conduction studies. Studies submitted with other diagnoses are considered not medically necessary and denied. Additional details for billing nerve conduction studies can be found in Medicare carrier Local Coverage Decisions (LCD). The LCD’s provide detailed conditions of coverage for nerve conduction procedures that address the following: type of procedures covered, number of nerves allowed, patients who are eligible to receive the procedure, requirements for providers of the procedure, the allowed testing frequency, and coding instruction.

Frequency of testing:
Electrodiagnostic testing frequency guidelines have been established according to the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM).

Repeat electrodiagnostic testing should not be necessary in a 12-month period in most cases. Tests refer here to assessment instance, not number of nerves tested. These guidelines have been incorporated into many Medicare and other payer policies.

These limits should not apply if the patient requires evaluation by more than one electrodiagnostic consultant (i.e., a second opinion or an expert opinion at a tertiary care center) in a given year or if the patient requires evaluation for a second diagnosis in a given year.

Additional tests may be required or appropriate over and above these guidelines. In such situations, the reason for the repeat test should be included in the body of the report or in the patient’s chart. Comparison with the previous test results should be documented.

Reimbursement:
Medicare, workers compensation carriers and other payers reimburse medical providers for nerve conduction studies. Payment amounts and coverage policies for specific procedures will vary by geographic location. To confirm reimbursement rates, consult with your local carrier or fiscal intermediary for specific procedure code reimbursement rates.

Location:
Nerve conduction studies are reimbursed in hospital and office settings.

The Medicare Diagnostic Related Group (DRG) covers the technical component of Medicare services for inpatients. When submitting bills to Medicare, the physician may only submit and be reimbursed for the professional component of these studies. While the physician cannot bill the carrier for the technical component under the DRG system, he may either bill the institution or establish a separate contract in order to receive the appropriate reimbursement. *This rule also applies to non-Medicare payers, utilizing the DRG payment methods.

Technical Specifications:
The NC-stat nerve conduction system meets or exceeds all the technical requirements for standard electrodiagnostic equipment. A detailed chart demonstrating each specification is available from NeuroMetrix by request.

The NC-stat System has received 510(k) clearance (K060584) from the Food and Drug Administration (FDA). The intended use of the NC-stat cited in the 510(k) summary states: “The NEUROMetrix NC-stat is intended to stimulate and measure neuromuscular signals that are useful in diagnosing and evaluating systemic and entrapment neuropathies.” The product has FDA 510(k) clearance for motor and sensory nerve conduction studies of all major nerves.