Wiki EMG billing

[amerzel20817]

Hi, we are receiving denials from BCBS for EMG codes 95886, 95912 stating that the primary Diagnosis is incorrect. In one case we billed G57.53 as a primary code with G60.9 and M54.16 as codes B and C. In the other case we billed G56.03 as the primary code and G56.23, G60.9 and M54.12 as the subsequent DX. BCBS representatives informed us that they are going by CMS policies but the CMS policy has all of these as correct ICD-10 codes as does Codify. Does someone have any light they can shed on this? Thanks, Anne Merzel. CPC-A Centers for Advanced Orthopedics, Maryland.

 

[PKOHUT]

Hi, we are receiving denials from BCBS for EMG codes 95886, 95912 stating that the primary Diagnosis is incorrect. In one case we billed G57.53 as a primary code with G60.9 and M54.16 as codes B and C. In the other case we billed G56.03 as the primary code and G56.23, G60.9 and M54.12 as the subsequent DX. BCBS representatives informed us that they are going by CMS policies but the CMS policy has all of these as correct ICD-10 codes as does Codify. Does someone have any light they can shed on this? Thanks, Anne Merzel. CPC-A Centers for Advanced Orthopedics, Maryland.

I am also from CAO and I am having the exact same issue. But as you mentioned, everything seems correct. Can someone give us any advice? Thanks, Patti

 

[shanamarie]

I am also from CAO and I am having the exact same issue. But as you mentioned, everything seems correct. Can someone give us any advice? Thanks, Patti

I don’t have my book handy, but I believe the M codes and G codes have an excludes note, so I would double check that.

 

[Cinzia78]

I am also from CAO and I am having the exact same issue. But as you mentioned, everything seems correct. Can someone give us any advice? Thanks, Patti

Hi, we are receiving denials from BCBS for EMG codes 95886, 95912 stating that the primary Diagnosis is incorrect. In one case we billed G57.53 as a primary code with G60.9 and M54.16 as codes B and C. In the other case we billed G56.03 as the primary code and G56.23, G60.9 and M54.12 as the subsequent DX. BCBS representatives informed us that they are going by CMS policies but the CMS policy has all of these as correct ICD-10 codes as does Codify. Does someone have any light they can shed on this? Thanks, Anne Merzel. CPC-A Centers for Advanced Orthopedics, Maryland.

G56.03 and M54.1- can't be billed together, there is an Exclude 1 limitation on G56.03 . G57.53 also can't be billed with M54.1- diagnosis. Check your 'Exclude 1' for all diagnosis billed. We have a lot of payers that used to pay before, but now they are following ICD-10 exact guidelines for Exclude1/2. BCBS & Aetna & UHC are now rejecting anything and everything even if the Exclude 1 is part of the encounter diagnosis but not CPT diagnosis