Article - Billing and Coding: Somatosensory Testing (A57540)

CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis 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 GuidanceQuantitative 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 RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.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.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.There should be evidence in the medical record that the test results were noted and influenced or contributed to the patients course of treatment.Documentation that the service was performed must be included in the patients medical record. This documentation should include a hard copy computer generated recording of the test results along with the physicians interpretation. The physicians 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.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 practitioners order for the studies.