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Thread: New EMG codes for 2013

  1. #1

    Default New EMG codes for 2013

    AAPC: CPC Promo
    Hi all

    2 issues

    First, I did bill a claim to MI BCBS (95885-59 x 1, 95885 x 1, 95911)

    BC paid 95911 but not the other 2 - denied: we need to know more about this service to tell if we can pay for it and if the member might also need to pay some. Please send us a new claim. Report the primary and add-on procedure codes you performed the same day.

    Has anyone else gotten the rejection? What did you do to fix it?

    Found out what happened - BCBS does not have the new codes loaded yet.

    Second, how would you code this:

    Motor Nerves:
    L Median - APB
    L Ulnar - ADM
    R Median - APB
    R Ulnar - ADM

    Sensory Nerves:
    R Median - 3rd Dig
    R Ulnar - Dig V
    L Median - 3rd Dig
    L Ulnar - Dig V
    R Radial - IDI

    Would this be 9 total or 5 total?

    OK, found out answer - this would be a total of 9 - so bill out 95911
    Thanks for the help

    Last edited by tdml97@yahoo.com; 01-28-2013 at 11:26 AM.

  2. #2
    Join Date
    Apr 2007
    Location
    Cherry Hill, NJ
    Posts
    286

    Default

    As far as the denial, I have no idea what that means. What else is there to know? Did you send docs the first time? Maybe appeal with them? As for the NCV that would be 9 total studies (4 separate motor nerves, and 5 sense nerves), so you would use whatever code includes 9. Hope I could help!

  3. #3
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,083

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    we bill the 95885 with LT and RT modifiers since it is for each extremity. also depends on the dx codes you used and how you linked them. if the 95885 was performed on the LT upper and the LT lower extremity then I do it as 95885 LT and 95885 59 LT also I list the 95911 first as the 95885 is an add on code.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007
    Posts
    47

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    Regarding the denial, I have had every payor deny these. I know they are wrong, so I have appealed each one. Their claim to me is that "959xx is not a primary code," which it is, because the 95886 is an add-on...

    The problem is that Medicare has it wrong, so the commercial payors use that as an excuse to deny, too, even if they know better.

    Write a nice letter of appeal, include copies of the CPT code descriptions, the AANEM position statement, EOB, original claim, and medical report.

    Appeal appeal appeal!

  5. #5

    Default EMG codes and rejectons

    I have tried anyway and everyway to code the new EMG codes and still they are being rejected. Any suggestion on what will get the codes paid. I have coded the NCV first and then listed the add on codes of the EMG. Please help!! The only insurance that I did not have a problem with was Cigna. It is like a big lets see what MEDICARE is going to do.

    Thanks,
    Deborah Childress
    Office Manager

  6. Default EMG's help!

    I am also having issues with the EMG coding for 2013. Does anyone have any insight on how to bill these now? I am getting denial after denial and I've tried multiple ways. I simply cannot afford to appeal every single EMG our office does.

    Emily Cumbow
    Director of Finance, CPC

  7. #7
    Join Date
    Apr 2007
    Location
    Lansing, Michigan
    Posts
    57

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    Our BCBS MI rep. come in and said that we are coding NCS/EMG's correctly, but it is their system that is causing out rejections. We code the NCS 95907-13, then 95886 x (However many extremities) so say 2. Codes 95860-95870 are only reported when NOT done with a NCS. I believe we are getting paid now, so hopefully that helps someone?

    Amanda Jent, CPC-A
    Coding Analyst

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