HealthNow UMD
Article -- Coding Guidelines

Contractor Name
HealthNow

Contractor Number
00801

Contractor Type
Carrier

Article Database ID Number
A34555

Contractor Determination Number
NE002G01 End dated

Article Type
Article

Article Title
Autonomic Nervous System Function Testing ­ 1 End dated

Is the AMA CPT / ADA CDT Copyright Statement Required?
Yes

CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other data of publication of CPT). All Rights Reserved. Applicable FARS/DFARS clauses apply. Current Dental Terminology (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. (C) 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Primary Geographic Jurisdiction
Upstate New York

Original Article Effective Date
06/24/2005

Article Revision Effective Date
07/29/2005

Article Ending Effective Date
04/25/2008

Coding Guidelines

1. The guidelines of the Correct Coding Initiative supersede all coding instructions in this LCD.

   2.  Use the appropriate CPT code without 26 or TC modifier when both the
       technical component of the test and the physician interpretation and
       report are performed by the same provider.

   3.  Use the TC modifier when only the technical component of the test is
       being billed.

   4.  Use modifier -26 when only the physician interpretation and report is
       being billed.

   5.  Do NOT use CPT code 93660 (Evaluation of cardiovascular function with
       Tilt Table evaluation) to report services described by CPT 95922
       "Autonomic nervous system function testing, vasomotor adrenergic
       innervation ... with at least five minutes of passive tilt."

   6.  Do NOT use CPT codes 95925-95927 (Short latency somatosensory evoked
       potential study) to report any of the services described by CPT codes
       95921-95922.

   7.  Do NOT use CPT codes 95921 and 95922 to report R-R interval trending
       or HRV (Heart Rate Variability) as an assessment of the risk of sudden
       cardiac death.  These measurements are available as features on some
       cardiovascular monitoring devices, and are not separately
       reimbursable.

   8.  Acceptable places of service for the professional and technical
       components and the global service are: office (11), Independent
       Diagnostic Testing Facility (IDTF) (11), and independent clinic (49).

   9.  For hospital inpatient (21) and hospital outpatient (22), only the
       professional component will be paid..

CPT/HCPCS Codes

    95921           Testing of autonomic nervous system function;
                    cardiovagal innervation (parasympathetic function),
                    including two or more of the following: heart rate
                    response to deep breathing with recorded R-R
                    interval, Valsalva ratio, and 30:15 ratio

    95922           ; vasomotor adrenergic innervation (sympathetic
                    adrenergic function), including beat to  beat blood
                    pressure and R-R interval changes during Valsalva
                    maneuver and at least five minutes of passive tilt

Other Comments
For services that exceed the accepted standard of medical practice and may be deemed not medically necessary, the provider/supplier should provide the patient with an acceptable advance notice of Medicare's possible denial of payment. An advance beneficiary notice (ABN) should be signed when a provider/supplier does not want to accept financial responsibility for the service.

This policy was converted to a LCD on 06/23/2005.

This article is end dated effective 04/25/2008 because it is no longer effective for educational purposes.

Does this Article contain a "Least Costly Alternative" provision?
No