Our physician performed 12 units of 95904. I know that Appendix J of the CPT code has a recommendation of 6 units for bilateral CTS testing. I wanted to seek some opinions and see if anyone was using modifier GD.
GD="Units of service exceed medically unlikely edit value and represents reasonable and necessary services."
Also, I've been reading a great deal of literature on Neurodiagnostic testing and wanted to get some input on how you bill the units when they are in excess of the recommendation allowance. In my scenario, I could bill...
1) 95904 x12 units on a single line or 2) separate the sensory NCS into two line items, such as 95904 x6 on one and 95904 x6 on the other. (with modifier 59 on the 2nd line)
The thought was that 95904 x 6 and 95904 x 6-59 would be a better coding scenario since a payer is likely to deny all 12 units instead of allowing 6 units and denying 6. I'm hearing that many payers will process the first line and deny only the second line for the additional units. This way...you only need to work those units that are out of the "norm" and appeal the remaining with medical necessity.
Anyone experiencing this?
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