Wiki Nerve Conduction Study

jbland

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I have a question. Normally when we do Nerve Conduction Studies, we also bill EMG as well. Sometimes, an EMG is not done due to patient refuses or unable to do. In a couple of cases I have billed just the nerve conduction study. It has been denied by Medicare and a couple of insurance companies as well.

I am billing 95909 x 1 POS 11
dx R20.1 and M79.642

denial reason for this one is CO-50 - non covered services because this is not deemed medical necessity by the payer.

Says it is based on LCD. Both of these Dx codes are covered.

What am I missing? I am sure it is something simple. I appreciate any help on this I can get.

Thanks!!
 
Are you billing this with a referring doctor? An NCV is a diagnostic study and Medicare requires a referring provider be listed on the claim for all diagnostic testing.
 
95909 is 5-6 studies.
M79.642 is pain in left hand
R20.1 is hypothesia of skin

What may be happening is that Medicare is saying that 5-6 studies is not medically necessary for those diagnoses. How many actual NERVES were tested? Not how many tests or studies, but how many nerves?

Also, have to checked the LCD to see if they cover NCV without EMG?
 
I have a question. Normally when we do Nerve Conduction Studies, we also bill EMG as well. Sometimes, an EMG is not done due to patient refuses or unable to do. In a couple of cases I have billed just the nerve conduction study. It has been denied by Medicare and a couple of insurance companies as well.

I am billing 95909 x 1 POS 11
dx R20.1 and M79.642

denial reason for this one is CO-50 - non covered services because this is not deemed medical necessity by the payer.

Says it is based on LCD. Both of these Dx codes are covered.

What am I missing? I am sure it is something simple. I appreciate any help on this I can get.

Thanks!!
We have trouble getting these paid if the EMG was not done with the NCS. I believe we have to appeal these based on the reason the emg was deferred or not done. I would look to see if the specific payor has a policy for that.
 
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