Hello, we are a neurology practice that bills for EMG/Nerve conduction studies 95886+95910 on same encounter. Novitas has been denying the 95886 EMG for frequency due to 12-month limitation for Radiculopathy when we do more than 2 study. Per Billing Article A54095 "the following number of tests per 12-month period per diagnosis per provider for repeat EDX assessment are suitable: 1) Two studies for carpal tunnel-unilateral, carpal tunnel-bilateral, radiculopathy, mononeuropathy, polyneuropathy, myopathy, and neuromuscular junction (NMJ) disorders.".
However patients are coming in for bilateral lower extremity EMG/NCS for lumbar radiculopathy on one day (95886x2 + 95910 that gets paid) , then later they come back for bilateral upper extremity EMG/NCS for cervical radiculopathy that gets denied (95886x2 + 95910)
Novitas denies the second study for frequency limitation, but they are separate body parts, upper extremities and lower extremities. We have been trying to appeal to Novitas with orders and medical records to support the different body part examined, but Novitas is denying our appeal. Anyone else have the same issue? We are sending second appeal to C2C but nothing has been reprocessed for payment yet. This just started to happen after 07/01/24 dos
However patients are coming in for bilateral lower extremity EMG/NCS for lumbar radiculopathy on one day (95886x2 + 95910 that gets paid) , then later they come back for bilateral upper extremity EMG/NCS for cervical radiculopathy that gets denied (95886x2 + 95910)
Novitas denies the second study for frequency limitation, but they are separate body parts, upper extremities and lower extremities. We have been trying to appeal to Novitas with orders and medical records to support the different body part examined, but Novitas is denying our appeal. Anyone else have the same issue? We are sending second appeal to C2C but nothing has been reprocessed for payment yet. This just started to happen after 07/01/24 dos