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new emg question

SuperCoder Posted Fri 10th of February, 2012 16:10:43 PM

i have been denied claims for emgs we used 95860 or 95861 then 95900*units and 95903*unites and 95904*unites they only pd for 95860 and 95861 how do i resubumit with the new codes95885 and 95886 and 95887

SuperCoder Answered Tue 14th of February, 2012 16:34:32 PM

When you check the CCI edits, you’ll find that the nerve conduction study codes (95900, 95903, and 95904) are each Column 2 codes for both the needle electromyography codes in question (95860 and 95861). The services represented by the NCS procedure codes are part of the EMGs. Code 95860 is also a Column 2 code of 95861. The edit explanations state that a modifier is allowed to differentiate the services and report both codes; you would append modifier 59 to 95860.

You have a similar situation with new needle EMG codes 95885, 95886, and 95887. Code 95887 is a column 2 code for 95885, but a modifier is allowed in order to differentiate between the services provided. If your physician provides all three services during the same encounter and has sufficient documentation, you should report 95885, 95887-59, and 95886.

As with any codes, check your payer’s guidelines to be sure you correctly report the NCS or EMG.

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