Wiki New emg/ncs codes

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seanny

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So I have studied the new EMG codes (95907-95913) and they seem straight-forward. Our reimbursements are about 70% less than before for these complicated and time-consuming diagnostic tests, which was sort of expected.

I'm having trouble with Humana, Medicare, and Medicaid. When I add the +95886 (add-on to show and EMG was performed in addition to the NCS (95912), it gets denied as "not payable seperately."

Does anyone else know how else to report and EMG and NCS together? Or can anyone offer any insight or has anyone else run into this?

I have appealed the Medicaid (may never hear back) and Humana, but am not holding my breath. It was my understanding that the code changes would help, but now I'm fighting the payors again.
 
I am puzzeling the same issue with one of my clients. There is no reason for this to be happening. But it seems to be widespread. If anyone has any insite it would be nice to hear from you.
 
I've seen the same denial on some of our EMG charges. I'm hoping (ha!) this this is just because the NCV codes are new, and that the payers have not updated their systems yet to show that the 95907-95913 are acceptable primary codes for 95885, 95886. I think giving it just a bit of time, then appealing, or getting them to reprocess, should take care of the problem...of course we see this every January with the updates. Seems like if we can be ready to bill the new codes, they should be ready to accept them!!! :D
 
Notice from Florida Medicare

This is from the Florida Medicare site (First Coast Service Options):
Incorrect denial of claims for CPT® codes 95885-95887

First Coast Service Options Inc. (First Coast) has discovered that providers may be receiving inappropriate denials. As a result of a processing issue, Current Procedural Terminology® (CPT®) codes 95885, 95886, and 95887 when billed with CPT® code 95907, 95908, 95909, 95910, 95911, 95912, or 95913 may have been denied in error. The result is an underpayment for claims with dates of service on or after January 1, 2013. This processing issue was corrected on January 30, 2013.

No action is required by providers at this time
First Coast is working to identify all services that have been denied in error and will make the appropriate adjustments. First Coast requests that providers do not submit appeal or reopening requests; it is unnecessary to call the customer services lines in regards to these incorrect denials. First Coast apologizes for any inconvenience this may have caused to impacted providers.
 
Im having the same problems here in Texas. But I do have a question if someone can clear this up for me? 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
 
95886

I have been getting denials from Medicare with the OA-18 Other Adjustments Exact Duplicate claim/service when I bill more than one unit of 95886. I bill 95886 one unit on one line. Should I bundle it or should I use a -59 on each subsequent line. I spent an hour on the phone with Medicare and they told me to use a -76. So I reopened a case and I got a call back stating -76 was not needed. How do I get these claims paid!!!!
 
rogeje said:
I have been getting denials from Medicare with the OA-18 Other Adjustments Exact Duplicate claim/service when I bill more than one unit of 95886. I bill 95886 one unit on one line. Should I bundle it or should I use a -59 on each subsequent line. I spent an hour on the phone with Medicare and they told me to use a -76. So I reopened a case and I got a call back stating -76 was not needed. How do I get these claims paid!!!!
Click to expand...

We've had this same problem with several payers. My suggestion (what has worked for us) is to bill the units on separate lines if multiple limbs are tested, with "59" on the additional lines. So in your example, 2 units of 95886 would be:

95886
95886-59

I can't say I agree with 76, because it is not repeating the exact same test; it is testing a different limb. My understanding on 76 is that it is only to be used if the exact same service is repeated.

Hope this helps! :)
 
Code 95886 is per extremity, so I've been coding with laterality.

I've been submitting
95886-RT
95886-LT

Medicare and commercial plans are paying this way, albeit very low allowables. Currently, it appears as though Medicaid (at least NC) wants:

95886-50.

Hope this helps! Good luck!
 
seanny said:
Code 95886 is per extremity, so I've been coding with laterality.

I've been submitting
95886-RT
95886-LT

Medicare and commercial plans are paying this way, albeit very low allowables. Currently, it appears as though Medicaid (at least NC) wants:

95886-50.

Hope this helps! Good luck!
Click to expand...


Just a thought, but what about if both units are for LT?...left arm and left leg? How do you differentiate the separate units that way?
 
I don't think there are any HCPCS mods for upper lower... Not sure if it would work, but I would try

95886-LT
95886-59-LT

I would try to submit the report, as well.
 
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