Wiki Nerve Conduction Studies - Audit Question

[christinemaddux]

Our office was recently audited by a third party agent through Medicare for services rendered back in 2011-2012 when the "old" codes were used for NCV testing. The results I am arguing because the supporting CMS guidelines they used do not make any sense to what they are stating in the individual patient audits. They are all the same, the response is:

CPT Code 95904, 16 units were billed: however, the documentation did not justify why 4 unites were completed above the recommended guideline. Therefore, the units have been adjusted to 12 units.

They are all similar to this, except some are over a threshold of 6 units so they are being adjusted. I have requested a discussion/education period on this to understand where they are coming from but hoping that someone could give some insight on what they are looking for? Our documentation clearly notes symptoms in specifics limbs and why we are testing them.


HELP!!!

 

[mhstrauss]

Our office was recently audited by a third party agent through Medicare for services rendered back in 2011-2012 when the "old" codes were used for NCV testing. The results I am arguing because the supporting CMS guidelines they used do not make any sense to what they are stating in the individual patient audits. They are all the same, the response is:

CPT Code 95904, 16 units were billed: however, the documentation did not justify why 4 unites were completed above the recommended guideline. Therefore, the units have been adjusted to 12 units.

They are all similar to this, except some are over a threshold of 6 units so they are being adjusted. I have requested a discussion/education period on this to understand where they are coming from but hoping that someone could give some insight on what they are looking for? Our documentation clearly notes symptoms in specifics limbs and why we are testing them.


HELP!!!

16 units of 95904 actually does sound like a lot. Can you possibly post a scrubbed note for one of these patients as an example? We do these in my clinic, I'd be happy to check it out for any issues.