I have searched and cannot find specific guidance related to if the "Comparison Summary" Studies can be counted. I am receiving many UHC denials.
I understand that we count each nerve OR branch of a nerve (ie RT Ulnar Seg Motor ABD and Right Ulnar Seg Motor FDI are counted separately, as they are listed individually in Appendix J).
I actually have 2 issues – UHC is denying the separate branches of the nerve stating the nerve can only be counted once despite Appendix J. I am appealing these. Has anyone else had this problem with UHC and have you been successful in your appeals?
My other issue is my testing provider, who is ABPTS Board Certified in Clinical Electrophysiology Testing & credentials PT, PMSK, ECS, and I disagree on whether or not the comparison studies can be counted separately. (Again these are being denied by UHC as we are over-coding.)
Example:
MOTOR SUMMARY
Right Median Motor (ABD Poll Brev)
Right Ulnar Seg Motor (ABD Dig Minimi)
Right Ulnar Seg FDI Motor (FDI)
SENSORY SUMMARY
Left Dors Cutan Sensory (Dorsum 5th MC)
Right Dor Cutan Sensory (Dorsum 5th MC)
Right Median D2 Sensory (2nd Digit)
Right Radial Sensory (1st Digit)
Right Ulnar D5 Sensory (5th Digit)
SENSORY COMPARISON SUMMARY
Right Median/Radial Sen Comparison (Digit 1) (Median Wst, Radial Wst)
Right Median/Ulnar Sen Comparison (Digit 4) (Median Wst, Ulnar Wst)
MOTOR COMPARISON SUMMARY
Right 2nd Lumb-Interos Motor Comparison (2nd Lumb Interos) (Median Wrist, Ulnar Wrist)
The testing provider is counting this as 11 nerves = 95912.
I’ve been told that the Comparisons don’t count separate, so I would get 8 nerves = 95910.
Any help/advice / reference material that you could provide to me would be Greatly appreciated!
Thanks! Tina