Wiki Carpal tunnel diagnosis for EMG

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CMS Denials for EMG's

No, carpal tunnel syndrome is a common Dx code used for NCS/EMG testing. I am not aware that we have received denials based upon the Dx codes. For Medicare there is a LCD (34635) that gives the guidelines for codes that are medically necessary and the Dx codes for Carpal Tunnel (G56.01, G56.02, G56.03) are within those guidelines. Where we are running into problems is when there is a NCS reported by one of our neurologists and they have not completed the EMG portion of the test for some reason or another. Those encounters have been denied and in most cases we have had to ask our Patient Financial Services folks of "adjust off" the charge. We have informed the physician what this means and have at least encouraged a reason for deferring the EMG be included in their notes/medical record.That is the MD gets the RVU credits but the charge is not paid by CMS. CMS insists in their guidelines that both tests must be completed together with just a few exceptions. I realized this more than answers your question!
 
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