Eli's Rehab Report

Question: Weve been receiving denials for tests such as nerve conduction studies (NCS) and somatosensory evoked potentials because we apparently performed the tests too soon (or too long) after an injury occurred. What is the proper timing to perform these tests?

New York Subscriber

Answer: For nerve conduction studies (95900-95904), somatosensory evoked potentials (95925-95927) and similar testing, conventional medical wisdom is that it takes four to six weeks for all of the changes to occur in nerve and muscle after an injury, and that each injury would require an examination to determine whether studies should be conducted. But insurers do not always agree with conventional medical wisdom practices. Many carriers have their own regulations on when these tests should be performed.

For example, Colorados nerve conduction study policy states, Nerve conduction studies are frequently useful immediately following an acute nerve injury such as a possibly severed nerve [such as 951.4, injury to facial nerve]. A delay in performing NCSs may result in a lost opportunity for therapeutic intervention. The policy, however, does not dictate a date by which the test must be conducted.

Empire Medicare Services local Medicare review policy, which would apply to your part B claims because you are in New York, does not dictate any timing guidelines for these services. If you have received denials for these services, contact your carrier and ask it to send you a copy of the specific guidelines that state the time restrictions for performing these services, and explaining why your claims were rejected.

With good documentation supporting the physicians rationale for performing the tests, you should be able to appeal these denials successfully. This is especially true in the absence of a local Medicare review policy stating any applicable time limits.