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Coding Medicaid for EMG & NCS

Linda Posted Mon 01st of April, 2013 12:51:30 PM

I am getting a denial of 7400 from Medicaid when billing for the EMG study. Could someone tell me how you should code for this when doing
NCS at same time?

SuperCoder Answered Tue 02nd of April, 2013 22:37:09 PM

A lot of confusion has existed among providers who do nerve conduction studies and try to bill for them. Choosing the appropriate units, differentiating between motor and sensory nerves, with or without F-wave and H-reflex testing has generated a lot of questions over the years. For 2013, hopefully the confusion will diminish. CPT codes 95900, 95903, and 95904 will be deleted and new nerve conduction study codes will be created. No longer will you need to differentiate between motor and sensory, F-wave test, or H-reflex test. You only need to count the number of studies and choose the corresponding code.
Per the CPT 2013 book, “For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with or without an F-wave test, or an H-reflex test. Each type of study (sensory, motor with or without F-wave, H-reflex) for each nerve includes all orthodromic and antidromic impulses associated with that nerve and constitutes a distinct study when determining the number of studies in each grouping (eg, 1-2 or 3-4 nerve conduction studies).”
CPT goes on to clarify that “each type of conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded. The numbers of these separate tests should be added to determine which code to use.” The new codes and descriptions follow.
95907 Nerve conduction studies; 1-2 studies
95908 Nerve conduction studies, 3-4 studies
95909 Nerve conduction studies, 5-6 studies
95910 Nerve conduction studies, 7-8 studies
95911 Nerve conduction studies, 9-10 studies
95912 Nerve conduction studies, 11-12 studies
95913 Nerve conduction studies, 13 or more studies
Remember, in 2012 new EMG add-on codes (95885-95887) were released for instances when they are performed in conjunction with nerve conduction studies. The instructions for using these codes have not changed.
*** Update: Many of you may be experiencing CO-107 denials from Medicare when billing the EMG codes (95885-95886) with the new NCS codes stating that a qualifying service was not identified on the claim. This was due to the claims processing system not being updated to allow the EMG add-on codes to be billed with the new NCS codes. As of 2/11/2013, this issue has been resolved. Those denials can be re-adjudicated through the re-openings process, or you can simply send another claim. ***
Check with your Medicare Administrative Contractor and other payers for information on reimbursement rates.

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