Wiki Reimburstment on EMG/NCV

[donnahoops]

Can someone tell me what I am doing wrong. We perform EMG's In which I usually have 13 plus nerves and atleast 1 complete study and 1 limited study. Diagnosis is never the issue. They deny every time due to needs additional information or separately billed services have been bundled as they are considered components of the same procedure. I send the report stating what was performed and the diagnosis to support medical necessity and they still come back denied. I appeal with a break down and we finally get reimbursement. I tried send in a paper claim with all supporting documentation first and still the same thing.

Example below:

95913 we did 13 nerves
95885-59 we performed limited study in the right leg
95886-59 x 2 we performed complete study on left arm and left leg

any help would be appreciated.

Thank you
Donna

 

[stlbill511]

I do not have any problem getting paid for these but I do not use the 59 modifier. Do not use any modifier.

Caroline

 

[stlbill511]

95885 is for 1-4 muscles and 95886 is for 5 or more muscles. I only use one of these for the total of muscles done. If it is done on two different limbs then total the muscles and use the appropriate code and times it by 2 with no modifier.

Caroline

 

[jennes285@yahoo.com]

If you are billing 95886 and 95885 together, but modifier XS on the 95885 as the lesser code to show separate limbs. You do not need to use a modifier on the 95886, and quantity bill the lines.