tci Part B Insider - 2009 Issue 12

READER QUESTION : Use Time and Modifiers Carefully When Reporting EMG Services

Tip: Counting minutes may not aid reimbursement. Question: Our physician performed EMGs in a hospital setting on four different patients. Three of them had Medicare and one had Wisconsin Medical Assistance. I billed them as an EMG and each insurer denied the charge because the insurer doesnt pay for EMGs at that place of service (hospital). How do I get paid for the extra time spent with these patients and for the EMG? Answer: You should report the corresponding CPT code with modifier 26 (Professional component) appended, which indicates you are billing only for the professional component. The insurer...

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