Bilateral conditions may require the neurologist to forego recommended testing limits
If you're reporting multiple electrodiagnostic (EDX) tests for the same patient, you may need to submit extra documentation to support your claim.
To ensure that you are not exceeding "reasonable and necessary" limits when reporting EDX tests, consult the American Association of Neuromuscular and Electrodiagnostic Medicine's Recommended Policy for Electrodiagnostic Testing. In the minority of cases when the neurologist determines that he must exceed the AANEM's testing recommendations, she should provide supplementary documentation to justify the additional testing. Refer to the Utilization Chart To prevent abuse and overutilization in your neurology practice, take the time to post the AANEM's "maximum number of tests necessary in 90 percent of cases" in a prominent location in your office.
The goal of the AANEM chart is to establish a baseline for the quantity of EDX testing required for a neurologist to diagnose a given condition. Many payers have adopted this chart as a model for their medical review policies on common diagnostic studies such as electromyography, nerve conduction studies, H-reflex, and others.
The number of tests that the AANEM policy recommends varies according to the suspected condition(s) or diagnosis(es). "In simple, straightforward cases, fewer tests will be necessary. This is particularly true when results of the most critical tests are normal," says Tiffany Schmidt, JD, policy director for the AANEM.
Internet resource: You can view the complete text of the AANEM Recommended Policy for Electrodiagnostic Testing at
www.aanem.org. AANEM Sets the Guidelines In most cases, neurologists should be able to diagnose a patient properly while still meeting the AANEM recommendations.
Example 1: The AANEM Recommended Policy for Electrodiagnostic Testing states that a minimal evaluation for radiculopathy "includes one motor and one sensory NCS [nerve conduction study] and a needle EMG [electromyography] examination of the involved limb" but that testing can include "up to three motor NCSs (in cases of an abnormal motor NCS, the same nerve in the contralateral limb and another motor nerve in the ipsilateral limb can be studied) and two sensory NCSs." The AANEM policy further explains that H-reflexes and F-waves may provide complementary data to evaluate suspected radiculopathy.
Example 2: Testing guidelines for mononeuropathy differ from those for EMG. To exclude radiculopathy, plexopathy or polyneuropathy, the neurologist may have to study "three motor and three sensory nerves including the clinically affected nerve, the same nerve on the contralateral side and an unaffected ipsilateral nerve. F-wave studies provide additional diagnostic information. A needle EMG examination in the affected limb is indicated," the AANEM policy says.
Important lesson: "You can't test and bill indiscriminately," Schmidt says. "Overutilization and overbilling harms the patient and adversely affects reimbursement for all physicians." Additional Testing Is OK, With Documentation If your [...]
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