Wiki Neurology/EMG Question

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albertha1

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I work in Neurology and we also do EMG's. However the new cpt code 95886 constantly keeps getting denied by stating it is not being billed with a primary code and needs a modifier. Cpt code 95885 is also being used in conjuction with 95886. I still cannot figure out what do I need to add along with these cpt codes?

Please Help

Thnaks

Belinda
 
albertha1 said:
I work in Neurology and we also do EMG's. However the new cpt code 95886 constantly keeps getting denied by stating it is not being billed with a primary code and needs a modifier. Cpt code 95885 is also being used in conjuction with 95886. I still cannot figure out what do I need to add along with these cpt codes?

Please Help

Thnaks

Belinda
Click to expand...

We're receiving the same type of denials; particularly, Medicare. I have a strong suspicion that the carrier(s) in question haven't updated their software with the new codes (95907-95913) . I have been sending the instructions from CPT as well as the AAN's guidelines. Hopefully, this will spark a light bulb above someone's head.
 
Resequenced CPT codes 95885 and 95886 (and 95887) are add-on codes to be listed separately, in additon to the new primary procedures 95907-95913.
 
Hello, I am having trouble with these new ncv codes. Our tech is saying that we should bill one way and our admin. says another? We are doing studies for carpal tunnel and for radiculopathy and paresthesia of the lower limbs. The question is when the new codes 95907-13 describe "studies" is that the quanitity? for example; we are studying 6 on the upper and 12 of the lower. Do I use the 95909 for the upper and 95912 for the lower? I read that for CTS you use 95907, is that because the CTS study was only once but the count of nerves is 3 so then I would bill 95907 x 3 units???
Please help!! I need clarification.. Thanks
 
There is hope...

albertha1 said:
I work in Neurology and we also do EMG's. However the new cpt code 95886 constantly keeps getting denied by stating it is not being billed with a primary code and needs a modifier. Cpt code 95885 is also being used in conjuction with 95886. I still cannot figure out what do I need to add along with these cpt codes?

Please Help

Thnaks

Belinda
Click to expand...

Just received this from Medicaid...


N.C. Medicaid Bulletin April 2013

Attention: All Providers

Electromyography Add-on Codes

Provider claims are currently being denied when the following two add-on codes are billed with any recommended primary codes (95907-95913). • 95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to the code for primary procedure) and,
• 95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to the code for primary procedure) HP is working to link the add-on codes with the new primary codes. Until system updates are completed, providers should continue to keep claims filed in a timely manner.
 
Actually, our Medicare admin has started paying on the 95886, after many appeals.

In our state, Medicaid is the only payor still denying. They told us we can wait for them to update the system, or appeal each claim to get paid faster.

I would keep billing them as directed and appeal, appeal, appeal.

The NCS is the primary code, and a modifier should only be required when done bilaterally. 95886, 7 are add on-codes, so should not require a modifier.
 
Belinda,

The 2 procedure codes you listed are BOTH add on codes. As such, you need a primary code to report in addition to these. Refer to CPT parenthetical notes which instruct coders to use 95885 or 95886 in conjunction with procedure codes 95907-95913. From the example you provided, it does not sound as if you reported the primary code, only 95885 and 95886. In addition, if you are reporting both add on codes 95885 and 95886 then the problem is that you are reporting both the limited and the complete needle EMG. Are you performing the complete on different extremities than the limited study? Are you performing the complete needle EMG during a different session than the limited one?

You cannot have both a limited and a complete needle EMG done on the same extremities during the same session on the same day/same patient/same provider.

Hope this has been helpful.

Maryann
 
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