Eli's Rehab Report
Appeal Your CS/EMG Denials
PDF
Question: I've been getting a denial using 95860-26 alongside 95903-26 or 95904-26, stating that this is not paid separately when done with another procedure. Is this true? You Be the Coder and Reader Questions were reviewed by Marvel Hammer, RN, CPC, CCS-P, CHCO, owner of MJH Consulting in Denver.
Rhode Island Subscriber
Answer: This is a strange denial because the National Correct Coding Initiative does not bundle electromyograms (EMG) and nerve conduction studies (NCS). You should appeal, and use the new Appendix J in the CPT book to help with your appeal. Appendix J clearly shows that EMG testing is often necessary in combination with NCS to diagnose a patient's symptoms and complaints.
Keep in mind: Typically the diagnosis is the same for both types of neuroelectrodiagnostic testing, if the provider performed them at the same session, whether it is needle EMG studies and/or NCS. The provider performs the selection of diagnostic tests and then determines a diagnosis based on the findings. If the studies are normal, you would use the sign/symptom code that was the indication for the tests originally.
No modifiers are necessary when you report both the needle EMG codes and the NCS codes. There are some NCCI issues for individual needle EMG codes and for the two motor NCS, but not for EMG and NCS.
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Appeal Your CS/EMG Denials
Question: I've been getting a denial using 95860-26 alongside 95903-26 or 95904-26, stating that this [...]