AANEM News Express

AANEM News Express

How to Deal with EMG Claims Denials

2/22/2012
 
CPT code changes in 2012 resulted in three new codes that are to be used when needle EMGs are performed on the same date of service as nerve conduction studies (NCS).  The new codes are:

95885    LIMITED needle EMG of extremity, done same day as NCS
95886    COMPLETE needle EMG of extremity, done same day as NCS
95887    Non-extremity needle EMG, done same day as NCS

Based on questions received from members, we want to remind you to:

ALWAYS report these codes in conjunction with NCS codes 95900-95904
NEVER report these codes in conjunction with EMG codes 95860-64, 95867-70

Handling insurance denials
If you are experiencing insurance denials for EMG services, the first step is to carefully read the explanations of benefits (EOBs) or remittance advice from the insurance carrier. “If you don’t understand the explanations given, don’t hesitate to contact the insurance provider,” stated Catherine French, AANEM director of health policy. “They are comfortable answering provider questions and welcome your calls.” She also suggested answering the following list of questions as you review your EOBs: 
  1.  Did you perform NCS and EMG together and report one or more of the new EMG codes?
If the answer is no, resubmit the claim using the new codes.
If the answer is yes, read on. 
  1. Are the denials you are receiving for services provided in the first 20 days of the year?
If yes, contact the payer.  Many payers did not have the new EMG codes loaded into their claims processing software on January 1st. A complete listing of a CPT code changes in 2012 can be found in appendix B of the CPT code book.You may need to send a copy of this list with your request for review.  
If the answer is no, read on.
  1. Are the denials stating the units of service are incorrect?
Yes – Advise the payer that codes 95885 and 95886 can be billed per extremity tested.  If you tested two extremities, you will bill two units.   Also advise the payer that these codes are excluded from the Medically Unlikely edits developed by the Centers for Medicare and Medicaid Services (CMS). If the payer refuses to acknowledge that, members can access the written statement here that you may attach to your appeal.
If the answer is no, read on.
  1. Are the denials stating a modifier is necessary?
Yes – Double check which CPT code is being flagged as needing a modifier.  When 95885 and 95886 are billed together, some payers will want the modifier -59 attached to 95885.  Some payers may also want to see modifier -59 on nerve conduction code 95900 if it is billed with 95903.

If you billed 95860-95864 instead of 95886, or 95870 instead of 95885, you will need to resubmit the claim with the correct EMG code and units of services for an EMG performed the same day as NCS.
 
"The best way to avoid a claim problem is to submit your claim correctly the first time,” French said. “As an AANEM member, you will receive timely updates on any future code changes that may impact your practice."

If you are not yet a member, join now.

If you have additional questions please contact policy@aanem.org


View Related News Stories:

  AdvocacyCoding and Billing


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