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Wiki Ncs - Need help coding the NCS
- Thread starter jmfarrer
- Start date
mhstrauss
True Blue
Are you getting "does not meet medical necessity" or "not covered by patient's plan" denials? What payers? What dx codes are being used?
Yes "does not meet medical necessity". Using CPT code 95909 , diagnosis code 354.1, then 345.2, on one patient and another patient 95909, diagnosis code 356.8.
From what is shown in Group 1 one the LCD listing for medical necessary these codes are approved.
Am I misunderstanding the coding?
Your help is much appreciated.
From what is shown in Group 1 one the LCD listing for medical necessary these codes are approved.
Am I misunderstanding the coding?
Your help is much appreciated.
Last edited:
mhstrauss
True Blue
I looked up the LCD for my MAC (Novitas JH), and agree that according to it, the dx codes you listed should be covered. The only other thing to consider is whether or not EMG was performed at the same time. The instructions at the top of the LCD indicate that Carpal Tunnel is pretty much the only dx allowed for NCS without EMG. IF EMG was performed on the same day...was it processed on the same claim as the NCS? We noticed awhile back that occasionally, the dx codes on the EMG and NCS were different, which caused them to not be processed together, and we got similar denials.
Not sure what other way to look at this. Hope it helps some!
mhstrauss
True Blue
Absolutely. Feel free to respond here, or message me directly! I don't mind helping at all.
Thank you for your help I think we are going to do NCS & EMGs on the same day since alot of our patients are not being tested for carpal tunnel.
Don't know who is making these decisions up there but they really should rethink this, alot of money will be paid out if both are done. I personally think that whomever is making this change is NOT a qualified neurologist nor do they understand how diagnosing patients can be done. But whatever, I will try this new way and keep you updated.
Don't know who is making these decisions up there but they really should rethink this, alot of money will be paid out if both are done. I personally think that whomever is making this change is NOT a qualified neurologist nor do they understand how diagnosing patients can be done. But whatever, I will try this new way and keep you updated.
After researching and reading all the NCCI edits on the above, I have come to the conclusion that we should just do both tests to cover all bases. Am using the codes of 95885 and 95886 for the EMG's because from what I understand these are the codes you are to use when you do both studies. the 95886 is for 5 more more muscles involving each extremity and also 3 or more nerves. My physician is very through when doing theses tests. I hope all my interruptation is correct on all fronts.
Thank you again and hope all is well.
Thank you again and hope all is well.
mhstrauss
True Blue
I'm not understanding your example completely. Are you saying that you are using ONLY 95885/95886, but not any codes from 95907-95913, when both EMG and NCV are performed? If so, that is incorrect. You will use one code from the 95907-95913 range, depending on the total number/types of nerves tested. And you will use either 95885 and/or 95886, depending on the number of muscles in each extremity being tested, possibly multiple units, depending on the number of extremities being tested.
mhstrauss
True Blue
No problem, happy to help. Have a good week also.