Wiki EMG billing

[amerzel20817]

Hi, we are receiving denials from BCBS for EMG codes 95886, 95912 stating that the primary Diagnosis is incorrect. In one case we billed G57.53 as a primary code with G60.9 and M54.16 as codes B and C. In the other case we billed G56.03 as the primary code and G56.23, G60.9 and M54.12 as the subsequent DX. BCBS representatives informed us that they are going by CMS policies but the CMS policy has all of these as correct ICD-10 codes as does Codify. Does someone have any light they can shed on this? Thanks, Anne Merzel. CPC-A Centers for Advanced Orthopedics, Maryland.

 

[PKOHUT]

Hi, we are receiving denials from BCBS for EMG codes 95886, 95912 stating that the primary Diagnosis is incorrect. In one case we billed G57.53 as a primary code with G60.9 and M54.16 as codes B and C. In the other case we billed G56.03 as the primary code and G56.23, G60.9 and M54.12 as the subsequent DX. BCBS representatives informed us that they are going by CMS policies but the CMS policy has all of these as correct ICD-10 codes as does Codify. Does someone have any light they can shed on this? Thanks, Anne Merzel. CPC-A Centers for Advanced Orthopedics, Maryland.

I am also from CAO and I am having the exact same issue. But as you mentioned, everything seems correct. Can someone give us any advice? Thanks, Patti

 

[shanamarie]

I am also from CAO and I am having the exact same issue. But as you mentioned, everything seems correct. Can someone give us any advice? Thanks, Patti

I don’t have my book handy, but I believe the M codes and G codes have an excludes note, so I would double check that.

 

[Cinzia78]

I am also from CAO and I am having the exact same issue. But as you mentioned, everything seems correct. Can someone give us any advice? Thanks, Patti

Hi, we are receiving denials from BCBS for EMG codes 95886, 95912 stating that the primary Diagnosis is incorrect. In one case we billed G57.53 as a primary code with G60.9 and M54.16 as codes B and C. In the other case we billed G56.03 as the primary code and G56.23, G60.9 and M54.12 as the subsequent DX. BCBS representatives informed us that they are going by CMS policies but the CMS policy has all of these as correct ICD-10 codes as does Codify. Does someone have any light they can shed on this? Thanks, Anne Merzel. CPC-A Centers for Advanced Orthopedics, Maryland.

G56.03 and M54.1- can't be billed together, there is an Exclude 1 limitation on G56.03 . G57.53 also can't be billed with M54.1- diagnosis. Check your 'Exclude 1' for all diagnosis billed. We have a lot of payers that used to pay before, but now they are following ICD-10 exact guidelines for Exclude1/2. BCBS & Aetna & UHC are now rejecting anything and everything even if the Exclude 1 is part of the encounter diagnosis but not CPT diagnosis

 

[amerzel20817]

I also received this feedback:
Payment for the services in question are made based on Medical Necessity. The criteria is attached. Anthem Blue Cross Blue Shield does not accept unspecified codes when a more specific code is available. Though the policy does not list specific ICD-10-CM codes, G60.9 is an unspecified diagnosis code. The specified diagnosis codes listed indicate that the patient has neuropathy in multiple nerves. Ulnar neuropathy and carpal tunnel syndrome are both types of peripheral neuropathy. When neuropathy affects 2 or more nerves, usually in similar areas on both sides of the body it is called polyneuropathy which provides specificity. It may be best to leave G60.9 off of the claim. However, review of the attached link policy, specifically regarding 95912 is recommended. Though 95912 uses the same clinical policy as 95886, there is a clinical edit indicating the requirement for use of a specific indication/diagnosis that must be present to meet the medical necessity requirements. 95912 requires post service medical necessity review upon claim submission. Reading the policy and comparing with the documentation for the service will help determine which specific diagnosis code will supply medical necessity.

https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_a057015.html

diagnosis codes, diagnosis coding