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EMG CODING AND MEDICARE

Peter Posted Wed 27th of June, 2012 20:54:17 PM

MY DOCTOR PERFORMS AN EMG, WHERE SENSORY NERVES ARE TESTED AND MOTOR NERVES ARE TESTED. WE BILL 95900 AND 95904. MEDICARE DENIED STATES A MODIFER IS MISSING.
WE UNDERSTAND MEDICARE IS NOT PAYING FOR CODE 95903. CAN ANYONE GIVE ANY ADVICE ON EMGS?

IS THERE A NEW LCD OR MODIFER REQUIREMENT FOR EMGS?

SuperCoder Answered Wed 27th of June, 2012 21:38:11 PM

Physical Medicine & Rehab Coding Alert: Get Paid for Nerve Studies Bundled by Erroneous CCI Edit

If you have submitted a recent claim for 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) and 95904 (nerve conduction, amplitude and latency/velocity study, each nerve; sensory or mixed) or 95903 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) and 95904 on the same date of service, you may receive a denial. A Correct Coding Initiative (CCI) edit issued in June began bundling the codes into 95904. The Health Care Financing Administration (HCFA) has since announced that it will delete the edit. If your claim was denied, you can resubmit it with modifier
-59 (distinct procedural service).

Tiffany Z. Eggers, JD, MPA, policy director/legislative counsel for the American Association of Electrodiagnostic Medicine (AAEM), reports that on June 5, HCFA instituted a CCI edit bundling CPT codes 95900 and 95903 into 95904. This edit has caused a large number of physical medicine and rehabilitation (PM&R) claims to be denied by Medicare and third-party payers who follow CCI edits. It also has prompted a wave of protests from PM&R providers.

CCI Edit to Be Deleted

HCFA informed the AAEM in a July 7 letter from Niles R. Rosen, MD, CCI medical director, that this edit will be deleted in the Carriers claims processing through CCIs Version 6.2 Update which is scheduled for an August 14 implementation date. Prior to August 14, providers can submit claims attaching the -59 modifier (distinct procedural service) to either code of each code pair edit. PM&R providers who already have had claims denied can either resubmit with the -59 modifier or wait until after Aug. 14 and resubmit without the modifier.

Until Aug. 14, the AAEM recommends that practices receiving denials when billing 95900 and 95904 or 95903 and 95904 on the same date of service write a letter to their local Medicare carriers, alerting the carrier that this was an erroneous CCI edit that is soon to be rectified. The statement (see box on page 59) also may be attached to the appeal to explain the difference between the nerve studies in question. If problems continue with the local Medicare carrier after Aug. 14, the practice may need to send another letter to the carrier director to remind them of the change.

Reminders on Billing Nerve Conduction Studies

Practices should be aware of several standards regarding nerve conduction study codes (see January 2000 Physical Medicine & Rehab Coding Alert article Increase Pay Up for Same-day Multiple Motor Nerve Conduction Studies on page 4). For example, both 95900 and 95903 can be billed for the same patient on the same day using modifier -59, provided that different nerves are being tested. Otherwise, the claim will be denied.

This is because a CCI edit prohibits billing the two codes together on the same day because the F-wave study (95903) includes the services of the motor nerve conduction study performed using 95900. Most Medicare carriers policies state that performance of an F-wave study requires minimal additional work when performed with a motor nerve conduction study, and therefore, only one of the two codes can be billed per day when testing the same nerve. When both tests are being performed on the same nerve, practices should bill only 95903.

Coders do not need to assign modifier -59 to claims for multiple units of any one of the nerve conduction study codes. For example, if a physiatrist is testing three nerves using the motor nerve conduction study without
F-waves, he or she would bill three units of 95900. According to HCFA, up to three units of 95903 can be billed. Codes 95900 and 95904 are listed as exclusions to the three-unit limit, however, and up to 12 units of 95900 or 95904 can be billed per visit.

CPT 2000 lists 95900, 95903 and 95904 as modifier -51 exempt, so practices should avoid using modifier -51 multiple procedures) with any of these codes.

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