CPT 95937 (neuromuscular junction testing (repetitive stimulation, paired stimuli) each nerve, any one method) is used for Neuromuscular Junction Testing and should not be used for Train of Four (TOF) Monitoring.
According to CPT guidelines, Neuromuscular Junction Testing is the stimulation of an individual motor nerve by means of repetitive electrical impulses with measurement of the resulting electrical activity of a muscle supplied by that nerve. According to the CPT AssistantApril 2002 Volume 12, Issue 4, under Electrodiagnostic Medicine – “repetitive stimulation studies are used to identify and to differentiate disorders of the Neuromuscular Junction (NMJ). This test consists of recording muscle responses to a series of nerve stimuli (at variable rates), both before, and at various intervals after, exercise or transmission of high-frequency stimuli.” The physician uses sensors to measure and record the nerve functions such as amplitude and conduction.
Physicians often use NMJ to diagnose patients with fatigable weakness to evaluate for possible disease of the Neuromuscular Junction. These diseases may include myasthenia gravis or myasthenic syndromes as well as botulinum toxicity. Rarely, exposure to certain drugs such as aminoglycoside antibiotics or D-Penicillamine can potentiate myasthenic symptoms.
According to AANEM’s (American Association of Neuromuscular & Electrodiagnostic Medicine) recommended policy for Electrodiagnostic Medicine, NMJ testing is performed to test disorders like myasthenia gravis and myasthenic syndrome.
Also per CMS contractor, Novitas Solutions, Inc.,“Neuromuscular junction testing must not be billed for any diagnostic test or procedure that does not meet the CPT definition of code 95937 {neuromuscular junction testing (repetitive stimulation, paired stimuli) each nerve, any one method}. Examples of tests or procedures not covered under this code of repetitive nerve stimulation include quantitative sensory testing by any means and sensory nerve conduction threshold testing. Tests depending on the patient’s subjective response to single or repetitive stimulation (electrical, vibratory, thermal or tactile), regardless of whether or not these data are analyzed and presented through electronic or computerized systems, also fail to satisfy the definition of CPT 95937.”
Train of Four Testing does not fit the criteria set by CMS and Insurance Carriers for CPT 95937.
Hence it is inappropriate to bill Neuromuscular Junction Testing code for Train of Four Monitoring. There is no separate code for Train of Four Monitoring.