Wiki Billing EMG/NCV extremities

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95886 has a Bilateral Status Indicator of 3 on the 2013 RVU Schedule..."The usual payment adjustment for bilateral procedures does not apply". My recommendation is to bill the 2 units on separate lines, with 59 on the second line. We have been doing it this way since these codes changed last year, and have not had trouble getting paid by any payers using the 59.

95886
95886-59

Hope this helps!
 
I, too, have been billing on two separate lines with modifier 59 and having that successfully paid all year. Now, all of a sudden, Cahaba GBA (Tennessee Medicare) is denying. Does anyone have information pertaining to what has changed?
 
UPDATE:
I just wrapped up a phone call with Cahaba GBA. Effective July 1, 1013, they are no longer accepting modifier 59 for additional extremities. They are requiring modifier 76 instead. I don't know what other carriers will be affected by this.

Example
Line 1 - 95886
Line 2 - 95886-76
 
shrewsburyfitk@aol.com said:
UPDATE:
I just wrapped up a phone call with Cahaba GBA. Effective July 1, 1013, they are no longer accepting modifier 59 for additional extremities. They are requiring modifier 76 instead. I don't know what other carriers will be affected by this.

Example
Line 1 - 95886
Line 2 - 95886-76
Click to expand...

Thanks for the info! I'll have to start watching for this issue with Novitas.

:)
 
I might be stating the obvious but are you using 95886 as an add-on code to primary procdures 95907-95913?
The NCS (95907-95913) is listed first as the primary procedure, then the add-on code (95885-95887). Also see Appendex J in the back of the CPT book. It was helpful to me.
 
Emg

In Texas I bill with no problems:
95909 or 95910 with KX modifier X 1unit
95886 X 2 units
Also on each line I put, Mfg, Model & Serial# in notes
 
cerullhon said:
If 2 extremites are tested, do we bill 95886 as 2 units? Do we append modifer 50? Thanks!
Click to expand...

If it is over 5 muscles I have been billing under 95886 RT 1 unit and 95886 LT 1 unit and getting paid ( if less than 4 muscles tested we use 95885 in the same way). We do not do uppers and lowers here on the same day so I do not code out for and upper and a lower. I have been getting paid with all my insurance plans here in Florida. (use we have to use the codes 95907-95913 also with those codes.
 
This is how I bill this:

First need to know number of muscles tested.

1-4 = 95885
5 or more = 95886

So, if you did over 5 for 2 extremeities - it would be 95886 x 2

If one was 4 and one was 6 - it would be 95885-59, 95886

If you had 4 on one, 5 on 2, 8 on one - it would be 95885-59, 95886 x 3

Hope this helps.

:)
 
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