Billing and Coding: Somatosensory Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33958 Somatosensory Testing. Please refer to the
LCD for reasonable and necessary requirements.

**Coding Guidance**

Quantitative Sensory Testing (QST) performed with portable hand-held devices
(e.g., current, vibration, thermal perception, or tactile) does not represent
somatosensory evoked potential testing and should not be billed using the
somatosensory codes (95925, 95926, 95927, or 95938). QST testing is considered
part of the evaluation and management service, and therefore, should not be
billed separately.

When billing for intraoperative somatosensory testing during spinal surgeries,
procedure code 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]) or
G0453 (Continuous intraoperative neurophysiology monitoring, from outside the
operating room (remote or nearby), per patient (attention directed exclusively
to one patient), each 15 minutes list in addition to primary procedure])
should be billed in conjunction with the study performed (95925, 95926, or
95927, or 95938). It would not be acceptable for the performing neurosurgeon
to bill for the intraoperative monitoring, as another provider performs this
while the surgery is in progress. Intraoperative monitoring performed by a
technician is not separately reimbursable. It is not expected that
intraoperative testing would be necessary for routine lumbar or cervical root
decompression.

Multiple services and/or the bilateral procedure modifiers do not apply, as
the code descriptors for these services include "stimulation of any/all
peripheral nerves or skin sites".

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. There should be evidence in the medical record that the test results were noted and influenced or contributed to the patient's course of treatment.
  5. Documentation that the service was performed must be included in the patient's medical record. This documentation should include a hard copy computer generated recording of the test results along with the physician's interpretation. The physician's SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal.
  6. If the provider of somatosensory testing is other than the ordering/referring physician/nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner's order for the studies.