Wiki EMG and Needles

[schanderson]

Good day,

I am so frustrated and have looked on this site and the so called American Academy of Neurology for the answer and I am just not seeing it at all. The patient has G56.02 and we just tested the one arm and it was 5 muscles, hence the 95909. However, I get the response from the insurance company that its denying the 95886 because it needs a modifier. I sent it back with an LT modifier since that has been the issue with Priority Health because it is in their policy. However, Wellcare still denies and stated it is because of what the American Academy of Neurology says about it. Would it need a modifier 59? I have seen others say that, but that makes no sense at all. I do not see anything from Medicare stating that these two codes cannot be billed together either. If there is a policy please direct me to it or do I just have to down code the 95909.

Sincerely,

Needles Cost!

 

[carlystur]

AAPC's Codify Scrubber says the following when I put in all of these codes:
"95886 - For private payers, consider modifier 51 with secondary and onwards code(s)
95886 - If you are reporting a bilateral procedure, append modifier 50 or RT/LT to 95886".

Have you tried modifier 51, maybe?