Wiki NCS with or without EMG

bridie25

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HELP!!

I have a new client that has been getting denials for Nerve conduction studies from Medicare. We have gotten some denials on the recent charges we submitted as well.

Medicare is denying 95907-95913 for invalid per LCD when I call I get two different reasons for the actual denial

1) it was not billed with a carpal tunnel dx, this is not a valid denial as 95905 is the only one on the LCD that will only accept Carpal tunnel, the rest will take multiple other dx codes including carpal tunnel. There is no * at the end of the DX code list to indicate that carpal tunnel is required.

2) it was not billed on the same DOS as an EMG, NOWHERE in the LCD does it state that these two test HAVE to be done on the same day. This doctor does the EMG first then reschedules the patient for the NCS.

Then it goes back to the carpal tunnel denial. They quote the following from the LCD:

When a 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-G56.03 should be used. All other diagnosis will be denied as not medical necessary.

This says specifically 95905- the rep I spoke to said its for the range of codes, I said it does not say a range it says 95905.

My issue is I don't want to appeal the 27 claims I have for them to say ok we will pay then I have to appeal EVERY claim for 95907-95913 that they incorrectly deny, that time and money the provider should NOT have to spend.

Not to mention they lost out on thousands from their charges prior to us taking over their billing that its too late for me to go back and fight. These would have also been incorrectly denied
 
Billing for EMG/NCS on different days.

If your provider is billing for these two procedures on different days then perhaps you are not following the CMS guidelines which require in most instances that both of these be conducted together. To bill these on different days is possibly giving CMS the idea that one of the procedures was not conducted; and that is found in the guidelines for most Dx codes in this LCD. They must be done together. I have had my providers decide to only do the NCS and not the EMG (for a variety of reasons) and it is then rejected by CMS. In those cases our financial people have to void out the charge. If these tests are done on different days I guess you could use 95860-95864 and 95867-95870 when billing for the EMG portion. I have found the guidelines are fairly clear and our managers have also read that these should take place on the same day. Would conducting the tests on different days possibly yield a different result than it they were conducted on the same day? Just asking.



I have a new client that has been getting denials for Nerve conduction studies from Medicare. We have gotten some denials on the recent charges we submitted as well.

Medicare is denying 95907-95913 for invalid per LCD when I call I get two different reasons for the actual denial

1) it was not billed with a carpal tunnel dx, this is not a valid denial as 95905 is the only one on the LCD that will only accept Carpal tunnel, the rest will take multiple other dx codes including carpal tunnel. There is no * at the end of the DX code list to indicate that carpal tunnel is required.

2) it was not billed on the same DOS as an EMG, NOWHERE in the LCD does it state that these two test HAVE to be done on the same day. This doctor does the EMG first then reschedules the patient for the NCS.

Then it goes back to the carpal tunnel denial. They quote the following from the LCD:

When a 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-G56.03 should be used. All other diagnosis will be denied as not medical necessary.

This says specifically 95905- the rep I spoke to said its for the range of codes, I said it does not say a range it says 95905.

My issue is I don't want to appeal the 27 claims I have for them to say ok we will pay then I have to appeal EVERY claim for 95907-95913 that they incorrectly deny, that time and money the provider should NOT have to spend.

Not to mention they lost out on thousands from their charges prior to us taking over their billing that its too late for me to go back and fight. These would have also been incorrectly denied[/QUOTE]
 
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