Wiki EMG/NCV issues with Medicare

[christinemaddux]

Hey everyone, our office has been having issues with Medicare processing both codes for EMG/NCV. Currently they are denying EMG stating we are missing a modifier. We are billing EMG w/ NCV codes

Example

95913
95886

They are paying NCV and denying EMG. This is sporadic so I cant say its a modifier that needs to be used on each one. The only thing I have noticed is some of them are billed the other way 95886 then the 95913

Any thoughts would be appreciated.

Thank you!

 

[marvelh]

Were any of the denials performed in a facility place of service? Medicare will not pay for the global diagnostic procedure in a facility POS as the technical component is included in the facility payment. Medicare requires use of modifier 26 to be reported when performed in a facility.

This may not be the reason but just a thought!