shrewsburyfitk@aol.com
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Hello,
There are, of course, new EMG codes that must be billed when EMG is done in conjuction with a nerve conduction study. I am having denial difficulties when billing for multiple units (multiple extremities) of 95886. Everything that I have read, including numerous documents published by the American Academy of Neurology, indicate 95886 x 2 (or the appropriate number of extremities) as one line item is accurate.
My carrier (Cahaba GBA - Tennessee) is denying this code when billed for more than one extremity. I have called them and they have told me that I must bill each extremity as separate line items, appending a modifier on each additional. They cannot tell me (aarrggghh)
which modifier they would like because that, of course, IS AGAINST THE RULES. Modifer 50 doesn't work because sometimes it's an upper and lower extremity as opposed to bilateral. Modifer 51 (multiple procedures) is inappropriate because it clearly states in the guidelines that it must not be used with an add on code. (95886 is an add on code.) My doctors do not think 76 (repeat procedure) is accurate because the second EMG is not a "repeat" as we are studying a different limb whose study will likely yield a different result. I can find no "special" Medicare specific modifer to cover this situation.
Does anyone have the answer or at least a good idea? I have emailed the American Academy of Neurology for assistance, but to date, have not had a response.
Many thanks,
Debbie Shrewsbury, CPC
There are, of course, new EMG codes that must be billed when EMG is done in conjuction with a nerve conduction study. I am having denial difficulties when billing for multiple units (multiple extremities) of 95886. Everything that I have read, including numerous documents published by the American Academy of Neurology, indicate 95886 x 2 (or the appropriate number of extremities) as one line item is accurate.
My carrier (Cahaba GBA - Tennessee) is denying this code when billed for more than one extremity. I have called them and they have told me that I must bill each extremity as separate line items, appending a modifier on each additional. They cannot tell me (aarrggghh)
which modifier they would like because that, of course, IS AGAINST THE RULES. Modifer 50 doesn't work because sometimes it's an upper and lower extremity as opposed to bilateral. Modifer 51 (multiple procedures) is inappropriate because it clearly states in the guidelines that it must not be used with an add on code. (95886 is an add on code.) My doctors do not think 76 (repeat procedure) is accurate because the second EMG is not a "repeat" as we are studying a different limb whose study will likely yield a different result. I can find no "special" Medicare specific modifer to cover this situation.Does anyone have the answer or at least a good idea? I have emailed the American Academy of Neurology for assistance, but to date, have not had a response.
Many thanks,
Debbie Shrewsbury, CPC
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