tci Medicare Compliance & Reimbursement - 2010 Issue 16

Reader Question: Counting Nerve Conduction Test Per Limb Will Result in Denials

Question: I coded my physician's diagnostic testing recently that included nerve conduction studies, an EMG, plus H-reflex testing. The doctor's final diagnosis was S1 radiculopathy (723.4). I billed all of the appropriate codes, plus an E/M code with modifier 25 in the following sequence: • 99213"25 • 95903"LT x 2 • 95903"RT x 2 • 95904"LT • 95904"RT • 95934"LT • 95934"RT • 95861. The patient's MAC denied a lot of the diagnostic studies. Why didn't we get paid for the full services provided? Answer: When your physician performs a nerve conduction study (NCS) and you code 95903...

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