Wiki emg billing need advice

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For the NCV billing, you shouldn't have separate codes for RT vs LT. Select one code that describes the total number of nerves tested for that encounter. Based on what you have here, I would think it would likely be 95913.
For the EMG, those codes could be correct, depending on payer preference for laterality modifiers. Most of ours allow 95885 x 2.

HTH!
 
95913 Medicare denials

We are starting to see a lot of denials from Medicare for the NCS 95913. Our previous neurologist always performed EMG on a later date separate from the NCS and we had no trouble getting paid in 2015. Now we have a new neurologist who likes to do EMG and NCS on the same day. We are using the add on codes for the EMG but they are being submitted on a separate claim. This is a workflow issue and we are working on getting both codes on the same claim. But this does not explain why NCS alone are being denied. The reason given is 'based on LCD'. The diagnosis codes used are on the LCD so I'm not sure what else could be the problem. Is anyone else having this issue with NCS? Anyone have any ideas? Any help or suggestion would be greatly appreciated.
 
lorrieb23 said:
We are starting to see a lot of denials from Medicare for the NCS 95913. Our previous neurologist always performed EMG on a later date separate from the NCS and we had no trouble getting paid in 2015. Now we have a new neurologist who likes to do EMG and NCS on the same day. We are using the add on codes for the EMG but they are being submitted on a separate claim. This is a workflow issue and we are working on getting both codes on the same claim. But this does not explain why NCS alone are being denied. The reason given is 'based on LCD'. The diagnosis codes used are on the LCD so I'm not sure what else could be the problem. Is anyone else having this issue with NCS? Anyone have any ideas? Any help or suggestion would be greatly appreciated.
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What is your MAC?
Did you read through the entire LCD? Or just look at the list of diagnoses? Most of the coverage articles I've seen (including my MAC, and our biggest commercial payers) will only allow NCV alone for CTS, and some other rare exceptions. For the most part, EMG needs to be performed in conjunction with NCV to be considered medically necessary. I don't believe this is a new thing.
 
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