The AAEM became aware of a Correct Coding Initiative (CCI) edit, in 2000, that bundled CPT™ code 95900 with 95904 and CPT™ code 95903 with 95904. The edit did, however, allow the codes to be billed together if an appropriate modifier was used. This CCI edit was enacted without prior notification to the American Medical Association (AMA) or National Medical Specialty Societies. It is our understanding that prior notification was not required because of the low frequency rate of occurrence. Unfortunately, the membership of AAEM (neurologists and physiatrists) frequently and appropriately bills these codes for the same patient, on the same date of service. Therefore the impact of the CCI edits on our membership has been immediate and severe. This edit went into effect June 5th, and over the past several weeks our association has received an influx of calls from members experiencing the effects of this change. The AAEM, along with the American Academy of Neurology (AAN) and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) wrote a letter to HCFA stating that bundling these codes was inappropriate. This letter may be viewed on the AAEM Web Site at www.aanem.org. Key members of the AAEM and AAEM staff also worked hard to contact the proper officials at HCFA and bring this problem to immediate attention. As detailed in the AAEM’s position statement, Explanatory Statement: Mixed Nerve Conduction Studies, motor, sensory, and mixed nerve conduction studies (NCS) are separate and distinct tests, which study separate and distinct types of nerves. Conventional motor and sensory NCSs cannot be bundled together into a single mixed nerve conduction study; they should be coded separately. Study of the sensory, motor, and mixed nerve fibers of a given nerve constitutes 3 separate and distinct services and should be billed and reimbursed accordingly. In response to our requests, HCFA has decided to delete both of these edits retroactive to June 5, 2000! These deletions will be installed in the Carriers’ claims processing systems through NCCI’s Version 6.2 Update that is scheduled for an August 14, 2000, implementation date. Unfortunately, HCFA has stated that because the procedures for dealing with deleted NCCI edits are well established at the carriers, they will not be sending a special instruction to the carriers regarding these two edits. Instead, they suggest that, “Prior to August 14, 2000, providers can submit claims attaching the –59 modifier to either code of each code pair edit. Since NCCI edits are national HCFA correct coding policy, carriers should not deny claims with the –59 modifier attached based on the NCCI edits. If providers have had claims with dates of service on or after June 5, 2000 denied because of one of these NCCI edits, they can either resubmit them currently attaching the –59 modifier to either code in a code pair edit or wait until after August 14, 2000 at which time the claims can be resubmitted for reprocessing without the –59 modifier.” You can view and print HCFA’s official letter informing us of the repeal. In addition to HCFA’s recommendations above, the AAEM highly suggests that you take the following steps:
These actions will help you receive appropriate reimbursement and will make Medicare Carriers and third party payors aware of the change. If you have any further questions, please contact the AANEM’s Policy Department Director, Megan Fogelson, at (507) 288-0100.
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