Wiki EMG/NCS done separately - Medicare denying

[knbiggs]

I need help! Medicare denying the NCS done on a separate day than the EMG. The patient was on blood thinners so they were separated. Medicare paid the EMG but denying the NCS as not medically necessary. I do now know why. Can someone please give me their input? thanks in advance

 

[tina1999]

Make sure your using the correct NCV codes 95908-95913 to bill the nerve conduction part of it and also make sure the diagnosis code your using is correct with the CPT code your billing. Check their LCD's MCR is very specific in how many units they will approve for certain diagnosis codes so if your trying to bill 95913 and back pain is your only diagnosis code MCR does not like that dx code with this CPT code. Hope this helps!

 

[dwaldman]

I agree that checking your Medicare local coverage determination policy would be important. Below is from WPS Medicare J5, of EMG to be performed in conjunction with NCS. You will to do an appeal showing that both studies were performed and the reason why they were on separate days.

"Nerve conduction studies performed independent of needle electromyography (EMG) may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. When the nerve conduction study (NCS) is used on its' own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can be misleading, and important diagnoses may be missed.

In most instances, both NCS and usually EMG are necessary to perform diagnostic testing. While a provider may choose to perform just an NCS, when performed alone it is usually considered not medically necessary. The only exception to this is a situation when a provider may consider it appropriate to perform an NCS without doing an EMG for the diagnosis of carpal tunnel syndrome with a high pre-test probability."

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34594&ContrId=148