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NCS with or without EMG

HELP!!

I have a new client that has been getting denials for Nerve conduction studies from Medicare. We have gotten some denials on the recent charges we submitted as well.

Medicare is denying 95907-95913 for invalid per LCD when I call I get two different reasons for the actual denial

1) it was not billed with a carpal tunnel dx, this is not a valid denial as 95905 is the only one on the LCD that will only accept Carpal tunnel, the rest will take multiple other dx codes including carpal tunnel. There is no * at the end of the DX code list to indicate that carpal tunnel is required.

2) it was not billed on the same DOS as an EMG, NOWHERE in the LCD does it state that these two test HAVE to be done on the same day. This doctor does the EMG first then reschedules the patient for the NCS.

Then it goes back to the carpal tunnel denial. They quote the following from the LCD:

When a beneficiary has a high pre-test or a priori probability for having the diagnosis of Carpal Tunnel Syndrome, the NC- Stat system (alone) will be allowed, one service per arm, using CPT code 95905, the diagnosis code G56.00-G56.03 should be used. All other diagnosis will be denied as not medical necessary.

This says specifically 95905- the rep I spoke to said its for the range of codes, I said it does not say a range it says 95905.

My issue is I don’t want to appeal the 27 claims I have for them to say ok we will pay then I have to appeal EVERY claim for 95907-95913 that they incorrectly deny, that time and money the provider should NOT have to spend.

Not to mention they lost out on thousands from their charges prior to us taking over their billing that its too late for me to go back and fight. These would have also been incorrectly denied

Medical Billing and Coding Forum