Wiki NCS w/o EMG

[cmtm849]

I have a Dr who insists on doing NCS w/o EMG and I am struggling to Medicare to pay them. Dx is in LCD. Do I need a Modifier??

 

[mhstrauss]

I have a Dr who insists on doing NCS w/o EMG and I am struggling to Medicare to pay them. Dx is in LCD. Do I need a Modifier??

What diagnosis is being used?
Have you read through the LCD and not just the list of dx? CTS is one of the only dx that most payers will pay for NCS w/o EMG, and even with that, there are guidelines. The rest of the dx on the list require both EMG in conjunction with NCS.

 

[cmtm849]

thank you Meagan

Was under the impression that you should always 'shy away' form the actually DX code of Carpel Tunnel because it automatically creates a situation of "is it a Work Comp situation?" I will talk with my doctor to get agreement that it's OK the change the DX code and we will see what happens. Thanks so much for your reply. Charlene

 

[sarab86]

Im in Florida and this is what the LCD here states. We don't do NCVs alone for this reason.

CPT code 95905 -Nerve conduction studies performed using automated devices (for example devices such as NC-stat® System) cannot support testing of other locations and other nerves as needed depending on the concurrent results of testing and must not be billed with the current CPT codes.

When the beneficiary has a high pre-test or a priori probability for having the diagnosis of Carpal Tunnel Syndrome, the NC-stat® System (alone) will be allowed, one service per arm, using CPT code 95905. The diagnosis code G56.00-G56.02 should be used. All other diagnosis codes will be denied as not medically necessary.

I hope this helps some

 

[knbiggs]

Here in oklahoma, when doing a NCS without EMG portion, its usually because they are on an anticoagulation rx ... it is very strict.. i had to appeal all of mine!

 

[rarens223]

Here in oklahoma, when doing a NCS without EMG portion, its usually because they are on an anticoagulation rx ... it is very strict.. i had to appeal all of mine!

I am having the exact same problem here in Nebraska. Were your claims paid after the appeals? Would you be willing to tell me what you included in your appeals?