Advancing Neuromuscular, Musculoskeletal, & Electrodiagnostic Medicine

AANEM's News Stories

2013 EDX Code Set Inappropriately Causing Insurance Denials

1/30/2013
 
Have you been experiencing claims denials of EMG codes 95885-95887 when billed with the new nerve conduction study (NCS) codes 95907-95913?

“I suspect most payers’ inability to accurately process claim in 2013 is due to an edit left over from 2012,” explained Catherine French, AANEM director of health policy.

To help resolve the issue, AANEM has been in contact with Medicare Administrative Contractors and has developed an appeal letter that members are encouraged to use when communicating with payers about denials for EMG codes. 

Last year, EMG codes 95885-95887 were flagged to only be reimbursed when paid with NCS codes 95900-95904, which were were deleted in 2013. 

The 2013 CPT coding guidelines make it clear that EMG add-on codes 95885-95887 need to be submitted along with a nerve conduction code from the 95907-95913 range to properly report the services provided. However, some payers may continue to have old claim edits that have not been updated or removed. Additionally, payers may not have set new edits to recognize the new NCS codes as the appropriate base code for the EMG add-on codes.

“Members can and should be reporting both an NCS code and an EMG code when performing both studies on the same day,” said French. 

We have also received complaints regarding denials related to units of service for NCS. An appeal letter has been developed specifically for you to use for these types of denials.

Visit the AANEM Coding Toolkit for additional resources related to the 2013 CPT coding changes.