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codes 95900, 95903, & 95904

cvzzz

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Hi! We were recently given a paper by a rep. and told to bill these 3 codes, didn't get alot of details or information on this. Our practice (Orthopaedics) billed a few of these and now we are receiving denials from some of the insurance companies. We are not sure what we are doing wrong? We will call the insurance companies to get some more insight on this but if anyone has any suggestions that would be great!

Thanks!
 

cvzzz

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95900,95903, and 95904

I have an office visit for a certain date with all 3 codes 95900-TC 2 units, 95903-TC 4 units and 95904-TC 6 units billed for MC. MC denial states lacks info for adjudication. Some of the denials they will pay 2 codes but not the third?

Also one from med mut they just say they will not pay something that is considered a part of a comprehensive service.

I hope that is enough info. Any help would be great!

Thanks.
 

mitchellde

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Columbia, MO
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Did you pull the codes from the studies performed? Also these are usually scheduled in advance so you should not have an E&M on the same date, that would be rare. I never bill with units greater than 1 for these as the codes are for each nerve, I always list multiple times with the 59 modifier, if the report supports that the 95900 and the the 95903 were on different nerves then you will 59 modifier on all the 95903 codes. Also are you using the TC modifier because your provider did not provide the supervision or interpretation of the study? And you only own the equipment? I still have many questions.
 

cvzzz

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EMG/NCV studies

Ok I had to get all the information on this. This is what I am being told, on the charge sheet they are listing for exp: 95900 TC 2 units, 95903 TC 4 units and 95904 TC 6 units. The understanding I have is the EMG doc is using our facility to come to and perform these tests and in return there is an agreement between the physicians that we will capture the TC. I believe the EMG Doc brings the equipment with him.

Please advise.

Thanks
 

mhstrauss

True Blue
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Baton Rouge
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Ok I had to get all the information on this. This is what I am being told, on the charge sheet they are listing for exp: 95900 TC 2 units, 95903 TC 4 units and 95904 TC 6 units. The understanding I have is the EMG doc is using our facility to come to and perform these tests and in return there is an agreement between the physicians that we will capture the TC. I believe the EMG Doc brings the equipment with him.

Please advise.

Thanks
Yes, there are several different issues in play here.

1. If the EMG Doc brings the equipment with him, then he probably owns it. In that case, he should be billing the TC portion himself. Why isn't he using his own office for this?

2. 95900 & 95903: If these 2 tests are performed on the same nerve, only bill 95903. If they are performed on different nerves, use mod 59 on 95900.

3. Multiple units: This will vary by payer. For the example you listed above, some payers may want to see it this way:

95900(LT or RT) x 2
95903(LT or RT) x 4
95904(LT or RT) x 6

But others may want to see it like this:

95900
95900-59
95903
95903-59
95903-59
95903-59
95904
95904-59
95904-59
95904-59
95904-59
95904-59 ...with LT or RT on each line

Most of the payers we accept will accept the first way; I think Aetna is the only one we use the second way.

Hope this helps some!
 
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