AANEM Connect

I have posted on this before.  The AANEM office suggested I post this to the forum to see if there are other physicians experiencing this issue.

I am starting to see billing warnings from other insurance companies (besides Humana who flat out denies) saying a patient can’t have carpal tunnel syndrome and cervical radiculopathy at the same time.  This combination frequently occurs in patients. 

And now the software system is also saying/warning that patients can’t have lumbosacral plexopathy and radiculopathy, even though there are patients with symptoms and findings that could be possible plexus and possible radiculopathy clinically where the EMG doesn’t definitively rule out one or the other and additional anatomical imaging or other work up is needed. 

This is looking like a trend where the insurance company will deny if these diagnoses are submitted together but will also deny higher nerve conduction codes like 95913 saying it isn’t necessary for “just” carpal tunnel or “just” cervical radiculopathy or any other limited diagnosis codes submitted. 

Perhaps AANEM would have more clout in going to insurance companies on this.  I have submitted position letters from AANEM with appeals, but many times it doesn’t work.  The insurance companies don’t give a s… about me as a solo practitioner and they have no incentive to do what is fair. 

 Thank you. 

Janet Balbierz, M.D.