Medicare Compliance & Reimbursement

Exceed carrier limits the legitimate way -- here's how When you're coding for nerve conduction studies (NCS) in a clinical setting, you're smart to be cautious -- before you file that claim, let our experts guide you through all of the coding-related bumps in the road ahead. Put Appendix J to good use: Check out CPT's Appendix J, says Meredyth Hurt, CCS-P, with Sky Lakes Medical Center in Klamath Falls, OR. This appendix includes a table explaining the maximum number of studies physicians need to make a diagnosis in 90 percent of patients. You should always check your local payer policies to see whether they have similar requirements, says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, with the University of Rochester Medical Center in NY. "Medicare does have a unit restriction," Hurt says. "I use the left (LT) and right (RT) modifiers if procedures go over six units. It's best to know how your payers want these procedures billed." Don't forget your documentation: Providing the carrier with more information is always the key to coding success. If your physician performed more than the maximum number of diagnostic studies indicated in Appendix J, be sure she indicates the compliant use of the codes as well as the need to perform that number of studies, Wink-Sturgeon says. If the number of procedures exceeds the Correct Coding Initiative (CCI) guidelines, you should include the physician notes to support the medical necessity. "You might have some trouble with carriers if the patient has three studies in the same year," Hurt says. "But if you have sufficient medical necessity, you can appeal. Every carrier has different criteria for the maximum number of studies it will pay." Advice: Hurt offers one final piece of advice. "Don't be afraid to appeal," she says. "I have had such a good success rate in my appeals for nerve conductions that I would encourage everybody to appeal."