Wiki EMG's and Medicare Refusing to Pay

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schanderson

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I have been trying for two months now to get Medicare to pay for 95886 and 95910 it was done on both sides. First they refused to tell me anything and said refer to the denial codes. Well it was saying that it needed a HCHPCS modifier. I have tried modifier 50 it was denied. I have tried 59 and it was denied for lack of HCPS modifier. Now I tried it with 59 and RT for and LT on the other line for 95886. I have looked in my CPT manual and just am flustered. I cannot find anything on this. Please help me to uncover the problem. Or do I need to tell the physician to not do both sides of the patient at one setting. My office keeps looking into it further and they are saying a diagnosis issue. The patient has G609 and M54.16.
 
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The code can only be used once per day per MUE edits. How many tests total are being conducted? Add them up and that is the code you are looking for.

"A report is generated on site that interprets the numerous test results at each site tested. Each type of study is reported only once regardless of the number of times performed on the same nerve in different areas. Report 95907 for up to two studies; 95908 for three or four studies; 95909 for five or six studies; 95910 for seven or eight studies; 95911 for nine or 10 studies; 95912 for 11 or 12 studies; or 95913 for 13 or more studies."
 
So you are saying I can only use 95910 once despite him using it on both legs?
 
Ncs/emg

If I understand these correctly...
Dr preformed:

NCS
Left Sural Anti Sensory (Lat Mall)
Left Medial Plantar Ortho Sensory (Med Malleolus)
Left Fibular Motor (Ext Dig Brev)

EMG
LT L3 PARASP
LT L4 PARASP
LT L5 PARASP
LT S1 PARASP
LT VASTUS MED -FEMORAL
LT BICEPSFEMS - SCIATIC
LT GASTROC - TIBIAL
LT ANTTIBIALIS - DP BR FIBULAR
LT EXT DIG BREV - DP BR FIBULAR

SHOULD THIS BE CODED AS ?:
95908 - THREE STUDIES
95886 - 5 MUSCLES FOR 4 OR MORE SPINAL LEVELS

ALSO - BIG QUESTION???:confused:
CAN WE COUNT THE COMPARISON STUDIES?
SURAL ANTI SENSORY (LAT MALL) CALF
MEDIAL PLANTAR ORTHO SENSORY (MED MALLEOLUS)
FIBULAR MOTOR (EXT DIG BREV)

IF WE CAN, THIS WOULD RAISE MY STUDY TO 6?

GLPERSINGER, CPC
 
On NCS: Count each nerve tested regardless of extremity or laterality. (Two on the right side, one on the left is 3 total nerves).

Appropriate code selection is determined by the number of studies performed. It is appropriate to report these codes for sensory nerve conduction threshold (SNCT) testing since information on the nerve conduction, amplitude, latency, and velocity are provided. Sensory conduction testing, motor conduction testing (with or without F wave testing) or H-reflex testing are each considered a single conduction study and for coding purposes, are considered to be distinct when determining the number of studies to be reported. Each nerve conduction study is reported only once per nerve even when multiple sites of the same nerve are studied. Do not report motor and/or sensory nerve conduction studies (95905) separately when performed during the same encounter. These codes can be used in addition to an evaluation and management service when medical record documentation supports the assignment of the E/M code.

On EMG: Each extremity is one test (only differentiated by limited or complete studies.

Needle electromyography (EMG) records the electrical properties of muscle using an oscilloscope. Recordings, which may be amplified and heard through a loudspeaker, are made during needle insertion, with the muscle at rest, and during contraction. Report 95885 per limited study of an extremity and 95886 for a complete (five or more muscles) study of an extremity. Codes 95885-95886 can be reported for a total of four units if all extremities are tested.
 
EMG's/Medicare

Hi,

I have not had any issues with Medicare paying EMG's at our Neurology office other then when the provider adds 2 units to 95887. Medicare will only cover one unit. As far as I've seen, the only CPT that needs a modifier is when the 95885-(59) is also included. I just had an EMG with a 95911 (9-10 studies) and 95886 pay with no modifiers. Have you checked the Local Coverage Determination (LCD) policy from Medicare for your state to see if the ICD-10 codes you listed are covered? Also, may be a silly question, but is your provider a board certified physician to perform EMG's? I have run into a similar issue in the past with that scenario.

I wish you luck in getting this resolved!
 
schanderson said:
So you are saying I can only use 95910 once despite him using it on both legs?
Click to expand...

Did the doctor test 7-8 nerves in both legs? If that is the case then you would add them together as one CPT to 95913 13 or more nerves.

They are saying that you don't count the nerves based per extremity you add both extremities together to the total nerves tested.

The EMG is the only code you would bill with more than 1 unit or bilateral for the muscle groups tested per extremity.

Hopefully this helps!
 
shill4455 said:
EMG's/Medicare

Hi,

I have not had any issues with Medicare paying EMG's at our Neurology office other then when the provider adds 2 units to 95887. Medicare will only cover one unit. As far as I've seen, the only CPT that needs a modifier is when the 95885-(59) is also included. I just had an EMG with a 95911 (9-10 studies) and 95886 pay with no modifiers. Have you checked the Local Coverage Determination (LCD) policy from Medicare for your state to see if the ICD-10 codes you listed are covered? Also, may be a silly question, but is your provider a board certified physician to perform EMG's? I have run into a similar issue in the past with that scenario.

I wish you luck in getting this resolved!
Click to expand...


Hello,

How would you deal with 95887 denial for multiple units? I've tried splitting the units with LT,RT 59 modifiers, but I still get denials for more than 1 unit. Currently have BCBS claims with that issue. Per my understanding 95887 should be coded per site like 95885-886, but I also can't find supporting documents which might prove me right on this so I can appeal the denial.

Any insight would be helpful, thank you!
 
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