Eli's Rehab Report

Question: My Medicare carrier does not allow reim-bursement for electromyogram (EMG) tests (95860-95875) or nerve conduction studies (95900-95904) when used as first diagnosis tests for acute bone injuries. We are re-examining some bills we submitted, and are wondering what exactly constitutes an acute injury. Do exacerbations count?

Maryland Subscriber

Answer: A condition is considered acute when the patient is being treated for a new injury that is not the result of a condition the patient has already had. For example, injuries that occur suddenly during activities, such as a sprained ankle (845.00) or a fractured hand (815.00), are considered acute injuries. Overuse injuries, such as Achilles tendinitis (726.71), are considered chronic injuries.

An exacerbation is a temporary marked deterioration of the patients condition due to a flare-up of the condition being treated. If a patient with carpal tunnel syndrome (CTS, 354.0) sprained her wrist (842.00), that might be considered an exacerbation of her CTS. Therefore, before performing EMG or nerve conduction studies, you should ensure that the patients injury is not considered acute. Medicare often does not pay for acute injuries due to its rationale that the injury is usually easily diagnosed, and can be treated without complication.