LCD Reference Article Billing and Coding Article

Billing and Coding: Autonomic Function Tests

A54954

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A54954
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Autonomic Function Tests
Article Type
Billing and Coding
Original Effective Date
04/07/2016
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Social 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 Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35395, Autonomic Function Tests. Please refer to the LCD for reasonable and necessary requirements.

According to a report from Casellini et al (2013), use of an apparatus for testing electrochemical skin conductance (ESC) that "consist of two sets of large-area stainless steel electrodes for the hands and feet that are connected to a computer for recording and data-management purposes. The electrodes are alternately used as an anode or cathode, and a direct current incremental voltage of less than or equal to 4 V is applied to the anode. Through reverse iontophoresis, the device generates voltage to the cathode and a current (intensity of around 0.2 mA) between the anode and cathode proportional to chloride concentration. At low voltages (less than 10 V), the stratum corneum is electrically insulating, and only sweat-gland ducts are conductive [in theory]." The report continues saying the (ESC) "expressed in microSiemens (µS), is the ratio between the current generated and the constant DC stimulus (less than or equal to 4 V) applied to the electrodes. . . During the test, patients were required to place their hands and feet on the electrodes and to stand still for 2–3 min. The device produces ESC results for individual right and left hands and feet. It then calculates an average score between right and left hands and feet. All the ESC results [presented in this study] correspond to the average ESC between right and left sides for both hands and feet. . . Neither special subject preparation nor specially trained medical personnel are required."

Coding Guicance

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.

Sudoscan and similar devices, by definition, do not meet the description of Current Procedural Terminology (CPT) code 95923 in that the subject preparation, environmental requirements, and specially trained medical personnel requirements are not met. Therefore, to bill this type of testing report the unlisted neurological diagnostic CPT code 95999.

  1. When submitting claims to Novitas for Sudoscan and similar devices as described above, providers should report CPT code 95999. The word SUDOSCAN or the term ESC (electrochemical skin conductance) must be noted in the narrative/remarks field (Item 19) on the CMS-1500 claim form or the electronic equivalent.
  2. Cardiovagal innervation testing should be reported with CPT code 95921.
  3. Vasomotor adrenergic innervation testing should be reported with CPT code 95922.
  4. Sudomotor function testing should be reported with CPT code 95923.
  5. CPT code 95924 represents combined parasympathetic and sympathetic adrenergic function testing.
  6. Consistent with CPT direction, CPT code 95924 should not be reported with CPT codes 95921 or 95922.

Providers should refer to the current year CPT manual for assistance with the proper reporting for autonomic function testing.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(5 Codes)
Group 1 Paragraph

Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
95921 Autonomic nrv parasym inervj
95922 Autonomic nrv adrenrg inervj
95923 Autonomic nrv syst funj test
95924 Ans parasymp & symp w/tilt
95999 Unlisted neurological dx px
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(48 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 95921, 95922, 95923, and 95924.

Group 1 Codes
Code Description
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy
E10.49 Type 1 diabetes mellitus with other diabetic neurological complication
E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy
E11.49 Type 2 diabetes mellitus with other diabetic neurological complication
E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E13.41 Other specified diabetes mellitus with diabetic mononeuropathy
E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44 Other specified diabetes mellitus with diabetic amyotrophy
E13.49 Other specified diabetes mellitus with other diabetic neurological complication
E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy
E85.0 Non-neuropathic heredofamilial amyloidosis
E85.1 Neuropathic heredofamilial amyloidosis
E85.3 Secondary systemic amyloidosis
E85.4 Organ-limited amyloidosis
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
G23.0 Hallervorden-Spatz disease
G23.1 Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]
G23.2 Striatonigral degeneration
G23.8 Other specified degenerative diseases of basal ganglia
G56.83 Other specified mononeuropathies of bilateral upper limbs
G57.83 Other specified mononeuropathies of bilateral lower limbs
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G61.82 Multifocal motor neuropathy
G90.09 Other idiopathic peripheral autonomic neuropathy
G90.3 Multi-system degeneration of the autonomic nervous system
G90.50 Complex regional pain syndrome I, unspecified
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.59 Complex regional pain syndrome I of other specified site
I95.1 Orthostatic hypotension
R00.0 Tachycardia, unspecified
R55 Syncope and collapse
R61 Generalized hyperhidrosis
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the "ICD-10 Codes that Support Medical Necessity " section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R4

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT code either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 95999 in Group 1 Codes

01/01/2022 R3

Article revised and published on 01/20/2022 effective for dates of service on and after 01/01/2022 to reflect the Annual HCPCS/CPT Code Updates. The following CPT code has been deleted and therefore has been removed from the CPT/HCPCS Group 1 Codes and the ICD-10-CM Codes that Support Medical Necessity Group 1 Paragraph sections in the article: 95943. Also, minor formatting changes have been made throughout the Article.

11/14/2019 R2

Article revised and published on 11/14/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

03/21/2019 R1

Article revised and published on 03/21/2019 to add coding/billing information in response to removing CPT and ICD-10 codes and coding information from the corresponding LCD, L35395 Autonomic Function Tests, per Change Request 10901.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35395 - Autonomic Function Tests
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
01/20/2023 01/01/2023 - N/A Currently in Effect You are here
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Keywords

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