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Billing carpal tunnel code with cervical radiculopathy

Janet Balbierz9/21/23 5:32 AM (CDT)

I have had several claims (usually 95886 (1 or 2 units) and 95913) completely denied with Humana when the patient has both cervical radiculopathy and carpal tunnel. These are patients with very complicated histories and I have findings supporting diagnoses of both carpal tunnel and cervical radiculopathy (not to mention trauma histories that might expand the differential diagnosis to include plexopathy).  The claim is denied saying that the two codes (carpal tunnel and cervical radiculopathy) may not be billed together. I have written extensive appeal letters pointing out that patients can, and do, have more than one diagnosis including carpal tunnel and cervical radiculopathy. However, they still deny the entire claim. If I were only to bill one of those codes, I suspect they would deny part of the claim saying that  the number of nerve studies done is not justified by the code submitted. I also bill codes for neck pain. arm pain, numbness, hand pain etc, depending upon the details of the history and the findings). The Caretracker billing program will also flag claims that have those two codes but other insurance companies like Blue Cross will pay when those two codes are submitted together.  Only Humana has denied the entire claim.  I copied my last letter of appeal to the insurance commission but that hasn't helped either.  Has anyone else seen this and figured out how to handle it?  Thank you.

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