We have been getting numerous questions on EMG/NCS as to how to count specific nerves or how to code NCS with correct CPT 2013 codes, why our EMG codes are getting denied when billed with NCS codes, etc etc. This is an attempt to demystify all the coding and billing quandaries. AMA made changes to NCS codes as of Jan 1st 2013 and the new codes 95907-95913 replaced the old CPT codes 95900, 95903 and 95904. Per CPT 2013, a single conduction study is defined as a sensory conduction test, a … [Read more...]
How To Correctly Code New EMG Codes ?
In the past few days we received a lot of queries regarding EMG denials and new EMG codes so we decided to write a blog article on this topic. Hope our readers will find it useful. As of January 1st 2012, AMA has introduced 3 new EMG codes to be used in place of previous EMG codes (95860-95864, 95867-95870) when NCV (Nerve Conduction Velocity) testing and EMG are performed together on the same date of service on the same patient. It is very important to bill the claims correctly if EMG … [Read more...]
Why CPT 95937 Should Not Be Used For Train of Four (TOF) Monitoring?
CPT 95937 (neuromuscular junction testing (repetitive stimulation, paired stimuli) each nerve, any one method) is used for Neuromuscular Junction Testing and should not be used for Train of Four (TOF) Monitoring. According to CPT guidelines, Neuromuscular Junction Testing is the stimulation of an individual motor nerve by means of repetitive electrical impulses with measurement of the resulting electrical activity of a muscle supplied by that nerve. According to the CPT AssistantApril 2002 … [Read more...]
How To Correctly Code Your EMG Studies To Maximize Your Reimbursement?
Needle EMG is the recording and study of electrical activity of muscles using a needle electrode. Neurologists use EMGs to test the electrical activity of a skeletal muscle to provide a medical diagnosis on a patient. Although these are common procedures but coding them incorrectly can not only cause billing problems but often lead to audits. The Centers for Medicare & Medicaid Services (CMS) outlines clearly its recommendations for EMG billing in the Federal Register (issue of October … [Read more...]
Key to Getting Maximum Reimbursement For Your Intraoperative Neuromonitoring Procedures
The key to getting maximum reimbursement for your IONM procedures is to keep yourself upto date with the payers clinical guidelines. Each individual carrier publishes the policies which outlines the rules and regulations regarding the use of a particular CPT, its limitations of coverage and/or medical necessity of that procedure. It is amazing to see how one payer will pay for neurophysiological services for a spinal surgery due to disc degeneration while others may deny it stating not … [Read more...]
Changes in Intraoperative Neuromonitoring CPT codes and their Effect on Insurance Reimbursements
Have you seen a decline in your Intraoperative Neuromonitoring insurance reimbursements lately? Are you seeing more and more payersdenying your claims stating procedure was not medically necessary or procedure was experimental. Ever thought why - The answer to your question is changes in the medical policies and guidelines. Every Payer has their own clinical policies and they keep revising it from time to time. Recently AMA (American Medical Association) stated, beginning January 1st 2012, … [Read more...]
How To Correctly Bill Nerve Conduction Studies?
A nerve conduction study (NCS) is a neurological test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The nerve conduction test provides physicians with information about the functioning of the peripheral nerves including both the type of dysfunction and the likely location of its cause. It is used to help diagnose various diseases that impact the nerves. Coding and billing these procedures incorrectly … [Read more...]
Correct Way to Code and Bill Brain Mapping
Surgically removing brain tumors adjacent to "eloquent" or functional regions of the brain poses significant risks for causing neurological impairments. Brain Mapping is performed for such eloquent cortex identification or to determine where the motor/sensory transition exists. CPT 95961( Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician … [Read more...]
How to handle a denial by an Insurance carrier for Intraoperative Neuromonitoring services?
Once a denial is received, the first step should be to review the policy or LCD(Local Coverage Determination) by the carrier regarding the services in question to determine if the claim has been denied correctly or not. Once that is determined, the next step is to write an effective appeal letter clearly stating the medical necessity for that procedure. Include a copy of the Op Report, Copy of IONM interpretation report and a copy of the LCD/Policy from the insurance carrier highlighting the … [Read more...]
How to report EEG during Non Intracranial and Intracranial Surgery?
During non-intracranial surgery i.e carotid endarterectomy or stenting, cardiac surgery, CPT 95955[Electroencephalogram (EEG) during nonintracranial surgery] should be used. This code cannot be billed in conjunction with CPT 95920. Codes 95812 and 95813 are also used as EEG codes. CPT 95812 [Electroencephalogram (EEG) extended monitoring;41-60 min) and CPT 95813 [greater than 1 hour] can be used for intracranial surgery ( i.e. aneurysm clipping or coiling). These codes should only be billed … [Read more...]