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95886 (complete emg) denials - need help

  1. Angry 95886 (complete emg) denials - need help
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    Hello,
    There are, of course, new EMG codes that must be billed when EMG is done in conjuction with a nerve conduction study. I am having denial difficulties when billing for multiple units (multiple extremities) of 95886. Everything that I have read, including numerous documents published by the American Academy of Neurology, indicate 95886 x 2 (or the appropriate number of extremities) as one line item is accurate.

    My carrier (Cahaba GBA - Tennessee) is denying this code when billed for more than one extremity. I have called them and they have told me that I must bill each extremity as separate line items, appending a modifier on each additional. They cannot tell me (aarrggghh) which modifier they would like because that, of course, IS AGAINST THE RULES. Modifer 50 doesn't work because sometimes it's an upper and lower extremity as opposed to bilateral. Modifer 51 (multiple procedures) is inappropriate because it clearly states in the guidelines that it must not be used with an add on code. (95886 is an add on code.) My doctors do not think 76 (repeat procedure) is accurate because the second EMG is not a "repeat" as we are studying a different limb whose study will likely yield a different result. I can find no "special" Medicare specific modifer to cover this situation.

    Does anyone have the answer or at least a good idea? I have emailed the American Academy of Neurology for assistance, but to date, have not had a response.

    Many thanks,
    Debbie Shrewsbury, CPC
    Last edited by shrewsburyfitk@aol.com; 02-20-2012 at 03:45 PM. Reason: Changing heading to reflect that the problem is solved

  2. #2
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by shrewsburyfitk@aol.com View Post
    Hello,
    There are, of course, new EMG codes that must be billed when EMG is done in conjuction with a nerve conduction study. I am having denial difficulties when billing for multiple units (multiple extremities) of 95886. Everything that I have read, including numerous documents published by the American Academy of Neurology, indicate 95886 x 2 (or the appropriate number of extremities) as one line item is accurate.

    My carrier (Cahaba GBA - Tennessee) is denying this code when billed for more than one extremity. I have called them and they have told me that I must bill each extremity as separate line items, appending a modifier on each additional. They cannot tell me (aarrggghh) which modifier they would like because that, of course, IS AGAINST THE RULES. Modifer 50 doesn't work because sometimes it's an upper and lower extremity as opposed to bilateral. Modifer 51 (multiple procedures) is inappropriate because it clearly states in the guidelines that it must not be used with an add on code. (95886 is an add on code.) My doctors do not think 76 (repeat procedure) is accurate because the second EMG is not a "repeat" as we are studying a different limb whose study will likely yield a different result. I can find no "special" Medicare specific modifer to cover this situation.

    Does anyone have the answer or at least a good idea? I have emailed the American Academy of Neurology for assistance, but to date, have not had a response.

    Many thanks,
    Debbie Shrewsbury, CPC
    My opinion would be modifier 59; so, for example, if 2 extremities were tested, instead of billing this way:

    95886x2

    You would do this:

    95886
    95886-59.

    Hope this helps!!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. Default
    That does seem to be the only other possibility. I've tried to avoid modifier 59 as CMS states that it is over-utilized and abused, but they keep creating situations where you have no choice in the matter. Thanks for your input. It is greatly appreciated.

  4. Default
    Has anyone tried billing this way with success? Like everyone else I have a ton of denials and am hoping to find a resolution soon.

    95886
    95886 -59

  5. Default
    Valerie,
    I've rebilled all my claims in this manner. I have'nt had responses yet on these corrected billings. I'll be sure to post the outcome here as soon as I have some responses.
    Debbie

  6. Default
    Hi all,

    I finally have the answer! Processing on my rebillings came in today. When billing for two or more units of 95886, code as two line items appending modifier 59 to the second.

    Example:

    95886
    95886 - 59

    My claims coded in this manner were paid.

    Debbie

  7. Default
    I think it all depends on the Carrier. I do get paid by Aetna and UHC using units. Medicare on the other hand has only been paying me for the one I put the modifier 59 on and denied the one without as a duplicate. Very aggravating. We also bill WC and they do not recognise the new codes at all.

  8. Default
    BCBS of MI and Medicare have both rejected our second line of billing when we bill 95886 and 95886-59 as procedure included in other procedure. I'm not sure what they want since we've also tried billing x2. It's so frustrating. I plan on calling them but they always tell me "we're not billers" so I'm not sure what to do.

    Martha

  9. #9
    Location
    Austin, Texas
    Posts
    467

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