Wiki Medical Biller

[sharonippolito]

TO ALL CODERS WHO USE EMG AND NCV STUDIES CPT CODES:

I work for a Physiatrist who frequently conducts EMGs and NCV studies for up to 2 extremities. I am new to this practice, but I am told that until this year, we were able to bill for an EMG using code 95861 and bundle that with 95900-95904. Now, a healthcare company has informed us that this cannot be a bundled relationship. I've since reviewed the 2012 CPT coding book and see what codes can and cannot be bundled. We've since re-submitted a denial and gotten reimbursed because we submitted an EMG code 95861 and used a -59 Modifier. However, it appears that we may been able to benefit monetarily if we used other codes, i.e., the new EMG codes. Since our office will conduct NCV studies for mulitiple nerves, do we use the new code 95885 for example and bundle that with the NCV study code FOR EACH NERVE. Let's say that Dr. R. performs an EMG, 2 extremities and a NCV study Motor Nerves (95900), Motor, w/F-Wave Study x 2, and NCV Sensory Nerves x 2: What would be the best way to code for these services??
I was thinking that we'd have to use the new code for one extremity (95885) twice (one for each extremity), then code 95900-95904 for the NCV studies for EACH NERVE:
For example:
95885 Extremity 1 + 95900 Motor Nerves x 2;
95885 Extremity 2 + 95903 Motor, w/F-Wave Study x 2;
95904 NCV Sensory Nerves x 2

I would appreciate the help of someone who is or has worked with EMG and NCV codes.

We don't want to submit the wrong codes or submit codes that would be underbilling ourselves.

The new code 95885 pays less than half of what code 95861 pays. We certainly don't want to be accused of overbilling, BUT we do wish to recover reimbursement for fees that are rightfully ours.

HELP!

 

[mhstrauss]

TO ALL CODERS WHO USE EMG AND NCV STUDIES CPT CODES:

I work for a Physiatrist who frequently conducts EMGs and NCV studies for up to 2 extremities. I am new to this practice, but I am told that until this year, we were able to bill for an EMG using code 95861 and bundle that with 95900-95904. Now, a healthcare company has informed us that this cannot be a bundled relationship. I've since reviewed the 2012 CPT coding book and see what codes can and cannot be bundled. We've since re-submitted a denial and gotten reimbursed because we submitted an EMG code 95861 and used a -59 Modifier. However, it appears that we may been able to benefit monetarily if we used other codes, i.e., the new EMG codes. Since our office will conduct NCV studies for mulitiple nerves, do we use the new code 95885 for example and bundle that with the NCV study code FOR EACH NERVE. Let's say that Dr. R. performs an EMG, 2 extremities and a NCV study Motor Nerves (95900), Motor, w/F-Wave Study x 2, and NCV Sensory Nerves x 2: What would be the best way to code for these services??
I was thinking that we'd have to use the new code for one extremity (95885) twice (one for each extremity), then code 95900-95904 for the NCV studies for EACH NERVE:
For example:
95885 Extremity 1 + 95900 Motor Nerves x 2;
95885 Extremity 2 + 95903 Motor, w/F-Wave Study x 2;
95904 NCV Sensory Nerves x 2

I would appreciate the help of someone who is or has worked with EMG and NCV codes.

We don't want to submit the wrong codes or submit codes that would be underbilling ourselves.

The new code 95885 pays less than half of what code 95861 pays. We certainly don't want to be accused of overbilling, BUT we do wish to recover reimbursement for fees that are rightfully ours.

HELP!

Hard to say for sure without seeing the documentation. First question is: For 95900 & 95903...are the same 2 nerves being tested? If yes, you cannot bill for 95900. 95903 includes 95900 when performed on the same nerve. If no, add a 59 to 95900.

You are correct in stating that 95885 pays less than half of what 95861 does. But keep in mind that you will use 2 units of new code 95885 to describe the same work as 1 unit of previous code 95861. In essence, you are much closer to the previous reimbursement than you realize when you look at it this way.

Hope this helps! I'd be happy to answer more questions; feel free to message me directly if you'd like.

 

[tdml97@yahoo.com]

Been having same issue

This is what we found:

You have to use 2 things - number of extremities tested & number of muscles tested

So say you did both arms - 1 - 4 muscles tested, 2 - 6 muscles tested

95885
95886
95900-59 x
95903 x
95904 x

If you have same but - 1 - 5 muscles tested, 2- 6 muscles tested

95886 x 2


Hope this helps

 

[rhommes@imsaz.org]

Max Frequency billed per day 95885

I work for a Neurologist and we have been billing the NCVS & EMG's with the new codes, but have run into a snag. We billed UHC for 95903 x 6 units, 95904 x 7 units, & 95885 x 3 units. We were paid on 95903 & 95904 but we were only paid for 2 units of 95885. Our records prove that we preformed 95885 on both arms and the 3rd test was on the right leg. UHC is telling me they will only pay a Max of 2 units of 95885 per day. I found another web site that told me:

Advise the payer that codes 95885 and 95886 can be billed per extremity tested. If you tested two extremities, you will bill two units. Also advise the payer that these codes are excluded from the Medically Unlikely edits developed by the Centers for Medicare and Medicaid Services (CMS). If the payer refuses to acknowledge that, members can access the written statement HERE that you may attach to your appeal.

I am not a member of AANEM so I am not able to print this out. I have spent over an hour looking on CMS and was not able to find this documentation. Can anyone tell me with this?

Thank You

Rusty