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Lower extremity NCS being denied

Amanda Posted Tue 25th of February, 2014 13:32:46 PM

Hi! Medicare has recently started denying my doctors Nerve Conduction Studies when they are performed without the EMG. They told me these were denied because we did not use Carpal Tunnel as the dx code. However on three of these claims we did not even test the upper extremities. I have read the LCD and I still don't understand these denials. I am unsure how to appeal. I really hope someone can help!

Thanks,
Amanda

SuperCoder Answered Wed 26th of February, 2014 14:24:04 PM

We are working on it and will update you soon.

Amanda Posted Wed 30th of April, 2014 13:56:34 PM

Has anyone gotten any info on this, as I am still having problems with Medicare only.

SuperCoder Answered Fri 02nd of May, 2014 18:03:32 PM

Need to find out the CPT and ICD codes billed, the actual denial code and the Medicare contractor. Some only allow NCS without EMG for carpal tunnel diagnoses only

Amanda Posted Wed 07th of May, 2014 14:25:59 PM

We bill WPS Medicare and the CPT codes that have been denied are 95908, 95909, and 95910. The diagnosis code used the most on these claims were 782.0 with 729.5 being the second most used diagnosis. I did appeals on 4 of the these claims using the exact same wording on all 4 appeals and 3 were denied but 1 of them was approved for payment. This doesn't make much sense to me or to my providers. I would appreciate any advice anyone out there can give us.

Thanks,
Amanda

Amanda Posted Wed 07th of May, 2014 14:26:54 PM

Oh and the denial code we got from WPS on all of these claims has been CO-50 (Non-covered procedures).

Thanks!

SuperCoder Answered Mon 12th of May, 2014 00:26:19 AM

Is there any possibility for direct communication with this practice? The diagnosis codes listed are included in the WPS policy for nerve conduction studies but the denial for medical necessity could be due to several other reasons:
• Did the provider also perform EMG testing on the same day? The following is an excerpt from the WPS L31346 coverage policy:
Nerve conduction studies performed independent of needle electromyography (EMG) may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. When the nerve conduction study (NCS) is used on its own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can be misleading, and important diagnoses may be missed.

In most instances, both NCS and usually EMG are necessary to perform diagnostic testing. While a provider may choose to perform just a NCS, when performed alone it is usually considered be a screening exam. The only exception to this is a situation when a provider may consider it appropriate to perform a NCS without doing an EMG for the diagnosis of carpal tunnel syndrome with a high pre-test probability.
• Has the patient previously had electrodiagnostic testing?
• Was the 729.5 or 782.0 diagnosis code linked as the primary reason for the NCS testing on the claim form? Just having the diagnosis code listed on the claim but not linked as the primary reason will not meet the LCD criteria.
• What is the specialty of the provider performing the NCS testing?
• What type of machine is being used to perform the NCS testing?
There can be several reasons for not-medically necessary denials. If I could "see" the actual 1500 claim form de-identified from patient PHI, I might be able to identify the reason, but something in this puzzle just isn't quite adding up.

Amanda Posted Thu 15th of May, 2014 10:32:08 AM

Please feel free to contact me. My email is amanda@neurologyspecialists.net. Or you can contact me at 812-330-0303 ext 209.

Thanks,
Amanda

SuperCoder Answered Thu 15th of May, 2014 12:06:55 PM

My Team would be contacting you soon. We need CMS 1500 claim form from your side.

Thanks,

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