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NC Study and Medicare Denials

  1. Default NC Study and Medicare Denials
    Medical Coding Books
    Fellow neuro coders. Help

    We have been submitting claims to medicare for nerve conduction study and they have been denied as "medically unnecessary". Example of one clinical note:

    "This is a 71-year-old gentleman with pain in his legs.
    -
    DESCRIPTION OF RECORD: Right and left lower extremities were
    examined. Right and left peroneal nerve distal latencies, amplitudes,
    and conduction velocities were within normal limits. Right and left
    tibial nerve distal latencies, amplitudes, and conduction velocities
    were within normal limits. Right and left sural nerve distal
    latencies, amplitudes, and conduction velocities were within normal
    limits. F-wave studies performed on tibial and peroneal nerves showed
    100% F-wave occurrence in all nerves tested.
    -
    IMPRESSION: Unremarkable nerve conduction study of the lower
    extremities."

    This was billed as a 95909-26 with ICD 10 code M79.604
    if there is something missing in the documentation or should it be coded differently, I would like to know so I can inform the provider.
    Please advise. Thanks everyone

  2. #2
    Location
    Denver Colorado
    Posts
    287
    Default
    Was an EMG also performed and billed or just the NCS?

    Many of the Medicare LCD include similar verbiage to this excerpt from Noridian's policy:
    Nerve conduction studies performed independent of needle electromyography (EMG) may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. When the nerve conduction study (NCS) is used on its' own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can be misleading, and important diagnoses may be missed.

    In most instances, both NCS and usually EMG are necessary to perform diagnostic testing. While a provider may choose to perform just an NCS, when performed alone it is usually considered not medically necessary. The only exception to this is a situation when a provider may consider it appropriate to perform an NCS without doing an EMG for the diagnosis of carpal tunnel syndrome with a high pre-test probability

  3. Default
    No EMG was conducted. This is what I first thought that the two had to be performed. Though I was missing something. Thanks you for your reply!

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