ED Coding & Reimbursement Alert - 2010 Issue 16
Reader Question: Counting Nerve Conduction Test Per Limb Will Result in Denials
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Article Overview
This reader Q&A addresses coding and claim-processing issues for electrodiagnostic testing services reported with CPT and related Medicare guidance. It is aimed at coders, billers, and clinicians who submit or review claims for nerve conduction studies, EMG, and H-reflex testing, and it discusses how payer edits, bilateral reporting, and local coverage policies can affect payment.
Why This Topic Matters
Electrodiagnostic testing claims can be denied when services are billed in a way that does not align with payer processing rules. Understanding the general reporting and coverage considerations helps reduce claim rejections and improves compliance with Medicare contractor requirements and CPT conventions.
Article Sections
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Question
The reader presents a denied claim scenario involving diagnostic testing and asks why payment was reduced.
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Answer
The response discusses broad reporting considerations for electrodiagnostic testing, including nerve conduction studies, H-reflex reporting, bilateral claim presentation, and review of Medicare coverage guidance.
What You Will Learn
- How the article frames claim denial issues for electrodiagnostic testing
- What general reporting considerations are discussed for nerve conduction studies and H-reflex testing
- Why payer and Medicare coverage policies may affect payment for these services
- How CPT and Medicare contractor guidance are described in the article at a high level
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle personnel
- Neurology and electrodiagnostic clinicians
- Compliance reviewers
Codes Discussed
Modifiers Discussed
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