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medicaid payable code for nerve conducting studies

Ram Posted Mon 18th of March, 2013 18:14:36 PM

we were not paid for 95912 by all medicaid hmo.can any one suggest how to bill.

SuperCoder Answered Wed 20th of March, 2013 14:20:40 PM

Codes 95907-95913 describe one or more nerve conduction studies. Each type of nerve 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. For a list of nerves, see Appendix J.

Code 95912 is a new code. 95900, 95903, 95904 were deleted. The unit of service in codes 95907-95913 refers to the number of nerve conduction studies performed; whereas the unit of service in the previous codes 95900-95904 referred to each nerve. These changes were made in an effort to address the overlap and number of codes reported for a typical neurological assessment.

As per "Texas Medicaid Special Bulletin, No. 5" --> The added procedure codes 95907-95913, may be reimbursed as follows:

• The total component may be reimbursed to physician providers in the office setting and to hospital providers in the outpatient hospital setting.

• The professional interpretation component may be reimbursed to physician providers in the office, inpatient hospital, and outpatient hospital settings.

• The technical component may be reimbursed to physician providers in the office setting and must be submitted with an appropriate diagnosis code.

Also, the codes 95907-95913 are marked as “Medicaid rate hearing required” under “Medicaid Allowable” column (P. 30) - http://www.tmhp.com/CSHCN_Bulletin/TMB_05_HCPCS%20Special%20Bulletin%202013.pdf

May be you are submitting codes based on no. of nerves treated, and not based on total no. of tests performed.

Ram Posted Thu 21st of March, 2013 13:48:13 PM

we are billing 95912 - 1no.s and 95886-2no.s. Now medicaid stopped payment for 95886 also.plz advise

SuperCoder Answered Fri 22nd of March, 2013 16:52:17 PM

As per CPT guidelines: “Use 95886 when five or more muscles are tested in an extremity. Use 95885, 95886, and 95887 for EMG services when nerve conduction studies (95907-95913) are performed in conjunction with EMG on the same day.”

Use codes 95870 or 95885 when four or fewer muscles are tested in an extremity. Use codes 95860-95864 or code 95886 when five or more muscles are tested in an extremity.

Use EMG codes (95860-95864 and 95867-95870) when no nerve conduction studies (95900-95904) are performed on that day. Use codes 95885, 95886, and 95887 for EMG services when nerve conduction studies (95900-95904) are performed on the same day.

Report either code 95885 or code 95886 once per ex-tremity. They can be reported together up to a combined total of four units of service per patient when all four extremities are tested.

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