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Wiki E&M on same DOS as NCS/EMG - Mod 25

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cling2me2

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Is anyone else having an issue where insurances are denying or retracting payment for the E&M code on the same day as an NCS/EMG if the E&M does not have the modifier 25? I can find no CCI edit conflicts for this coding combination (example: 99213 & 95910 / 95886) therefore no modifier should be required on the E&M. We are having this issue with at least BCBS of NY, Fidelis & Aetna.
Any input would be appreciated. Thank you.
 
Hi - I can't speak to those specifically, but perhaps there's a payer-specific edit or a policy like this one (this is from NC, not NY): https://www.bluecrossnc.com/sites/d...ic/pdfs/medicalpolicy/bundling_guidelines.pdf

In that policy, it says, "Evaluation and Management service will be denied when billed on the same date as electromyography, nerve conduction tests or reflex tests, unless the evaluation and management service consisted of a significant, separately identifiable service."

You may find the topic on the neuro forum, too. Best of luck!
 
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