Monday, March 13, 2017

CPT FOR Neurophysiology evoked potential NEP

CPT/HCPCS Codes

Group 1 Paragraph: N/A

Group 1 Codes:
92585 Auditor evoke potent compre
92586 Auditor evoke potent limit

Group 2 Paragraph: N/A

Group 2 Codes:
95925 Somatosensory testing
95926 Somatosensory testing
95927 Somatosensory testing
95928 C motor evoked uppr limbs
95929 C motor evoked lwr limbs
95938 Somatosensory testing
95939 C motor evoked upr&lwr limbs

Group 3 Paragraph: N/A

Group 3 Codes:
95930 Visual evoked potential test



Coverage Indications, Limitations, and/or Medical Necessity

Background

Neurophysiology Evoked Potentials (NEPs) for the purpose of this LCD include:

Somatosensory Evoked Potentials/Responses (SEPs/SERs),
Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs), and
Visual Evoked Potentials/Responses (VEPs/VERs)
Evoked potential studies are recorded electrical responses to stimulation of a sensory system. When a sensory impulse reaches the brain, a specific Electroencephalographic (EEG) response is produced (evoked) in the cortical area appropriate to the modality and site of the stimulus. By computer averaging techniques, the evoked responses of repetitive stimuli can be separated from the spontaneous EEG activity. Evoked potentials are clinically useful in evaluating the functional integrity of the somatosensory or special sensory pathways. Different latencies and wave patterns help to localize lesions ranging from the end organ through the nervous system to the cerebral cortex. Often defects in these pathways are not otherwise evident. Evoked potentials are also used to monitor neural pathways when patients are anesthetized during surgery and to document brain death. The following are tests that evaluate potentials evoked by stimulation of the peripheral or cranial nerves:

SEPs/SERs evaluate the pathways from nerves in the extremities through the spinal cord, to the brainstem or cerebral cortex upon stimulation of peripheral axon.

SEPs has an advantage in that it evaluates the entire somatosensory pathway and it is possible to distinguish between lesions located in the peripheral nerve, in the dorsal column pathway, or both.

VEPs/VERs evaluate the visual nervous system pathways from the eyes to the occipital cortex of the brain. VEP or VER involves stimulation of the retina and optic nerve with a shifting checkerboard pattern or flash method. This external visual stimulus causes measurable electrical activity in neurons within the visual pathways. This is called the Visual Evoked Response (VER) and is recorded by electroencephalography electrodes located over the occiput. Using special computer techniques, the evoked responses measured over multiple trials are amplified and averaged. A characteristic waveform is produced. With pattern-shift VER, the waveform normally appears as a straight line with a single positive peak (100 msec after stimulus presentation). Abnormalities in this characteristic waveform may be seen in a variety of pathologic processes involving the optic nerve and its radiations. Pattern-shift VER is a highly sensitive means of documenting lesions in the visual system. It is especially useful when the disease process is subclinical, e.g., ophthalmologic exam is normal and patient lacks visual symptoms.

BAEPs/BAERs evaluate the auditory nerve pathways from the ears through the brain stem. A clicking sound is presented to one ear at a time. The electrical activity of this signal is recorded by electrodes on the scalp. The averaged response is displayed as a waveform that contains peaks and troughs, which correspond to various points along the hearing pathway. The time between these peaks is measured and compared to normal data. A delay in a component of the response might indicate an abnormality at specific anatomic sites in the acoustic nerve or brainstem.


Indications

Somatosensory Evoked Potentials and Responses (SEPs/SERs) (CPT codes 95925, 95926, 95927, 95928, 95929, 95938, 95939) are appropriate for the following indications:

Spinal cord trauma
Degenerative, non-traumatic spinal cord lesions (e.g., cervical spondylosis with myelopathy)
Multiple sclerosis
Spinocerebellar degeneration
Myoclonus
Coma
Intraoperative monitoring
Subacute combined degeneration
Other diseases of myelin (e.g., adrenoleukodystrophy, adrenomyeloneuropathy, metachromatic leukodystrophy, and Pelizaeus-Merzbacher disease
Syringomyelia
Hereditary spastic paraplegia
Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs) (CPT codes 92585 and 92586) are appropriate:

For one or more of the following conditions:

Asymmetric hearing loss
Unilateral tinnitus
Sudden hearing loss
Cerebellopontine angle tumor
Demyelinating disorder
Functional hearing loss
Ototoxic drug therapy monitoring including chemotherapy or antibiotics
Auditory neuropathy
Acoustic neuroma

Preoperative baseline for:

Posterior fossa surgery
Cochlear implant

Postoperative testing for:

Cochlear implant
Visual Evoked Potentials or Responses (VEPs/VERs) (CPT code 95930) are appropriate for the following indications:

Confirm diagnosis of multiple sclerosis when clinical criteria are inconclusive.

Detect optic neuritis at an early, subclinical stage.

Evaluate diseases of the optic nerve, such as:

Ischemic optic neuropathy
Pseudotumor cerebri
Toxic amblyopias
Nutritional amblyopias
Neoplasms compressing the anterior visual pathways
Optic nerve injury or atrophy
Hysterical blindness (to rule out)

Monitor the visual system during optic nerve (or related) surgery (monitoring of short-latency evoked potential studies).

Limitations

SEP studies are appropriate only when a detailed clinical history and neurologic examination and appropriate diagnostic tests such as imaging studies, electromyogram, and nerve conduction studies make a lesion (or lesions) of the central somatosensory pathways a likely and reasonable differential diagnostic possibility.

There is no need for SEPs in the diagnosis of most neuropathies because the conventional nerve conduction study can identify them and no added information is obtained from SEPs.



ICD-10 Codes that Support Medical Necessity


ICD-10 CODE DESCRIPTION

D33.3 Benign neoplasm of cranial nerves
G10 Huntington's disease
G21.0 Malignant neuroleptic syndrome
G23.0 - G26 - Opens in a new window Hallervorden-Spatz disease - Extrapyramidal and movement disorders in diseases classified elsewhere
G35 - G36.8 - Opens in a new window Multiple sclerosis - Other specified acute disseminated demyelination
G37.0 - G37.8 - Opens in a new window Diffuse sclerosis of central nervous system - Other specified demyelinating diseases of central nervous system
G80.3 Athetoid cerebral palsy
G90.3 Multi-system degeneration of the autonomic nervous system
H46.00 - H46.9 - Opens in a new window Optic papillitis, unspecified eye - Unspecified optic neuritis
H81.01 - H81.09 - Opens in a new window Meniere's disease, right ear - Meniere's disease, unspecified ear
H81.41 - H81.49 - Opens in a new window Vertigo of central origin, right ear - Vertigo of central origin, unspecified ear
H83.3X1 - H83.3X9 - Opens in a new window Noise effects on right inner ear - Noise effects on inner ear, unspecified ear
H90.3 - H90.8 - Opens in a new window Sensorineural hearing loss, bilateral - Mixed conductive and sensorineural hearing loss, unspecified
H91.20 - H91.23 - Opens in a new window Sudden idiopathic hearing loss, unspecified ear - Sudden idiopathic hearing loss, bilateral
H93.11 - H93.19 - Opens in a new window Tinnitus, right ear - Tinnitus, unspecified ear
H93.3X1 - H93.3X9 - Opens in a new window Disorders of right acoustic nerve - Disorders of unspecified acoustic nerve
H94.00 - H94.03 - Opens in a new window Acoustic neuritis in infectious and parasitic diseases classified elsewhere, unspecified ear - Acoustic neuritis in infectious and parasitic diseases classified elsewhere, bilateral
R25.0 - R25.9 - Opens in a new window Abnormal head movements - Unspecified abnormal involuntary movements
R42 Dizziness and giddiness



ICD-10 CODE DESCRIPTION

A18.01 Tuberculosis of spine
A52.11 Tabes dorsalis
A52.13 - A52.15 - Opens in a new window Late syphilitic meningitis - Late syphilitic neuropathy
A52.17 - A52.19 - Opens in a new window General paresis - Other symptomatic neurosyphilis
A69.20 - A69.22 - Opens in a new window Lyme disease, unspecified - Other neurologic disorders in Lyme disease
A69.29 Other conditions associated with Lyme disease
A83.0 - A83.8 - Opens in a new window Japanese encephalitis - Other mosquito-borne viral encephalitis
A84.0 - A84.8 - Opens in a new window Far Eastern tick-borne encephalitis [Russian spring-summer encephalitis] - Other tick-borne viral encephalitis
A85.2 Arthropod-borne viral encephalitis, unspecified
B00.4 Herpesviral encephalitis
B00.82 Herpes simplex myelitis
B02.24 Postherpetic myelitis
B05.0 Measles complicated by encephalitis
B06.01 Rubella encephalitis
C41.2 Malignant neoplasm of vertebral column
C70.0 - C70.9 - Opens in a new window Malignant neoplasm of cerebral meninges - Malignant neoplasm of meninges, unspecified
C72.0 - C72.9 - Opens in a new window Malignant neoplasm of spinal cord - Malignant neoplasm of central nervous system, unspecified
C79.31 - C79.49 - Opens in a new window Secondary malignant neoplasm of brain - Secondary malignant neoplasm of other parts of nervous system
D32.0 - D33.7 - Opens in a new window Benign neoplasm of cerebral meninges - Benign neoplasm of other specified parts of central nervous system
D42.0 - D43.2 - Opens in a new window Neoplasm of uncertain behavior of cerebral meninges - Neoplasm of uncertain behavior of brain, unspecified
D43.4 Neoplasm of uncertain behavior of spinal cord
D44.3 - D44.5 - Opens in a new window Neoplasm of uncertain behavior of pituitary gland - Neoplasm of uncertain behavior of pineal gland
D49.6 Neoplasm of unspecified behavior of brain
E03.5 Myxedema coma
E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified
E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E08.44 Diabetes mellitus due to underlying condition with diabetic amyotrophy
E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified
E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy
E09.44 Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy
E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy
E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy
E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
E13.44 Other specified diabetes mellitus with diabetic amyotrophy
E71.50 - E71.548 - Opens in a new window Peroxisomal disorder, unspecified - Other peroxisomal disorders
E75.23 Krabbe disease
E75.25 - E75.29 - Opens in a new window Metachromatic leukodystrophy - Other sphingolipidosis
F44.4 - F44.7 - Opens in a new window Conversion disorder with motor symptom or deficit - Conversion disorder with mixed symptom presentation
G05.4 Myelitis in diseases classified elsewhere
G06.1 Intraspinal abscess and granuloma
G11.0 - G11.8 - Opens in a new window Congenital nonprogressive ataxia - Other hereditary ataxias
G13.0 - G13.1 - Opens in a new window Paraneoplastic neuromyopathy and neuropathy - Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G23.0 - G23.9 - Opens in a new window Hallervorden-Spatz disease - Degenerative disease of basal ganglia, unspecified
G32.0 - G32.81 - Opens in a new window Subacute combined degeneration of spinal cord in diseases classified elsewhere - Cerebellar ataxia in diseases classified elsewhere
G35 - G36.8 - Opens in a new window Multiple sclerosis - Other specified acute disseminated demyelination
G37.0 - G37.8 - Opens in a new window Diffuse sclerosis of central nervous system - Other specified demyelinating diseases of central nervous system
G45.0 - G45.2 - Opens in a new window Vertebro-basilar artery syndrome - Multiple and bilateral precerebral artery syndromes
G45.8 Other transient cerebral ischemic attacks and related syndromes
G46.0 - G46.2 - Opens in a new window Middle cerebral artery syndrome - Posterior cerebral artery syndrome
G54.0 - G54.8 - Opens in a new window Brachial plexus disorders - Other nerve root and plexus disorders
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.40 - G56.42 - Opens in a new window Causalgia of unspecified upper limb - Causalgia of left upper limb
G57.00 - G57.92 - Opens in a new window Lesion of sciatic nerve, unspecified lower limb - Unspecified mononeuropathy of left lower limb
G58.7 Mononeuritis multiplex
G60.0 - G60.8 - Opens in a new window Hereditary motor and sensory neuropathy - Other hereditary and idiopathic neuropathies
G61.0 - G61.89 - Opens in a new window Guillain-Barre syndrome - Other inflammatory polyneuropathies
G62.0 - G62.89 - Opens in a new window Drug-induced polyneuropathy - Other specified polyneuropathies
G63 Polyneuropathy in diseases classified elsewhere
G65.0 - G70.89 - Opens in a new window Sequelae of Guillain-Barre syndrome - Other specified myoneural disorders
G73.1 - G73.3 - Opens in a new window Lambert-Eaton syndrome in neoplastic disease - Myasthenic syndromes in other diseases classified elsewhere
G80.0 - G80.2 - Opens in a new window Spastic quadriplegic cerebral palsy - Spastic hemiplegic cerebral palsy
G80.4 - G80.8 - Opens in a new window Ataxic cerebral palsy - Other cerebral palsy
G81.00 - G81.94 - Opens in a new window Flaccid hemiplegia affecting unspecified side - Hemiplegia, unspecified affecting left nondominant side
G90.3 Multi-system degeneration of the autonomic nervous system
G93.2 Benign intracranial hypertension
G95.0 - G95.19 - Opens in a new window Syringomyelia and syringobulbia - Other vascular myelopathies
G95.81 - G95.89 - Opens in a new window Conus medullaris syndrome - Other specified diseases of spinal cord
G99.2 Myelopathy in diseases classified elsewhere
I60.00 - I62.1 - Opens in a new window Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation - Nontraumatic extradural hemorrhage
I63.011 - I63.09 - Opens in a new window Cerebral infarction due to thrombosis of right vertebral artery - Cerebral infarction due to thrombosis of other precerebral artery
I63.111 - I63.19 - Opens in a new window Cerebral infarction due to embolism of right vertebral artery - Cerebral infarction due to embolism of other precerebral artery
I63.211 - I63.239 - Opens in a new window Cerebral infarction due to unspecified occlusion or stenosis of right vertebral arteries - Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid arteries
I63.30 - I63.49 - Opens in a new window Cerebral infarction due to thrombosis of unspecified cerebral artery - Cerebral infarction due to embolism of other cerebral artery
I63.59 - I63.6 - Opens in a new window Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery - Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I65.01 - I65.8 - Opens in a new window Occlusion and stenosis of right vertebral artery - Occlusion and stenosis of other precerebral arteries
I66.01 - I66.3 - Opens in a new window Occlusion and stenosis of right middle cerebral artery - Occlusion and stenosis of cerebellar arteries
I66.9 Occlusion and stenosis of unspecified cerebral artery
I67.1 Cerebral aneurysm, nonruptured
M05.50 - M05.59 - Opens in a new window Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site - Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M34.83 Systemic sclerosis with polyneuropathy
M40.00 - M41.9 - Opens in a new window Postural kyphosis, site unspecified - Scoliosis, unspecified
M43.8X1 - M43.9 - Opens in a new window Other specified deforming dorsopathies, occipito-atlanto-axial region - Deforming dorsopathy, unspecified
M47.011 - M47.029 - Opens in a new window Anterior spinal artery compression syndromes, occipito-atlanto-axial region - Vertebral artery compression syndromes, site unspecified
M47.11 - M47.16 - Opens in a new window Other spondylosis with myelopathy, occipito-atlanto-axial region - Other spondylosis with myelopathy, lumbar region
M50.00 - M50.03 - Opens in a new window Cervical disc disorder with myelopathy, unspecified cervical region - Cervical disc disorder with myelopathy, cervicothoracic region
M51.04 - M51.06 - Opens in a new window Intervertebral disc disorders with myelopathy, thoracic region - Intervertebral disc disorders with myelopathy, lumbar region
M51.9 - M53.1 - Opens in a new window Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder - Cervicobrachial syndrome
M96.2 - M96.5 - Opens in a new window Postradiation kyphosis - Postradiation scoliosis
Q05.0 - Q05.9 - Opens in a new window Cervical spina bifida with hydrocephalus - Spina bifida, unspecified
Q07.00 - Q07.03 - Opens in a new window Arnold-Chiari syndrome without spina bifida or hydrocephalus - Arnold-Chiari syndrome with spina bifida and hydrocephalus
R20.0 - R20.9 - Opens in a new window Anesthesia of skin - Unspecified disturbances of skin sensation
R26.0 - R26.1 - Opens in a new window Ataxic gait - Paralytic gait
R26.81 - R27.9 - Opens in a new window Unsteadiness on feet - Unspecified lack of coordination
R29.5 Transient paralysis

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