In response to a request from AANEM, United Healthcare announced this morning its plan to correct an error that has impacted provider reimbursement nationwide. United Healthcare will reprocess all 2013 electrodiagnostic (EDX) claims that were incorrectly denied electromyography (EMG) add-on codes 95885-95887 when billed with the nerve conduction study (NCS) codes 95907-95913 (new in 2013).
“United Healthcare staff worked quickly to identify the issue,” states AANEM Senior Policy Analyst Catherine French. “We anticipate the resolution to be as seamless as possible.”
If your office received United Healthcare claim denials in January that included a reason code of COB15, “service requires a qualifying procedure,” you do NOT need to appeal the claim. United Healthcare has indicated they will systematically identify the denied services and will automatically reprocess the claims.
Coding Resources to Help You
If your office receives denials
from any payer when billing EMG codes 95885-95887 in conjunction with NCS codes 95907-95913, there are a few things you can do:
Alert the AANEM
The rejection of a valid CPT code is a violation of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA-covered entities–including payers–are required to use the current applicable code set. AANEM staff will work with you to educate the payer and, if necessary, file a complaint with the Centers for Medicare and Medicaid Services. Report your coding denials to policy@aanem.org.
Send an Appeal Letter
AANEM is in contact with several Medicare administrative contractors and has developed an appeal letter for members to use when communicating with payers. Log in at www.aanem.org/2013changes for a copy of the appeal letter.
Visit the Coding Toolkit
View the frequently asked questions document at www.aanem.org/2013changes, which may help you work through remittance advice or explanation of benefits from payers.