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I am Confused! NCS and 64450

  1. #1
    North Carolina
    Exclamation I am Confused! NCS and 64450
    Exam Training Packages
    Am I reading this correctly???

    There are edits placed against 95900/95904 and 64450. 95900/95904 are bundled into 64450 and can not be overridden with a modifier. But here's my problem...

    64450 was performed on the left side of the arm and 95900/95904 was performed on the right...

    Obviously opposite anatomical locations. Is this edit an error???

  2. #2
    Sioux Falls South Dakota
    I went out and checked, and it's been there for some time. According to the explanation on Ingenix Encoder Pro, it's due to "standards of medical/surgical practice".

    When I coded for our Rehab/Physical Medicine doctors, they just never did anything else if they were doing EMG/NCS.

    Wish I could be more help!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. Default
    The only thing I can suggest because you seem to have a unique circumstance is to code all 3 codes and add mod -59 to the 64450. I know what CCI edits say but you are on a separate site.

    Let the claim deny and then appeal with the report and cover letter pointing out that these are 2 unrelated procedures performed on different sides of the body

    Other than that, don't know what to suggest

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