On April 1, 2012, a National Correct Coding Initiative (NCCI) edit went into effect, again changing the way physicians who perform EMGs are required to bill their services for CMS. A modifier now is required when performing a limited study of four or fewer muscles (95885) on one extremity and a complete study of five or more muscles (95886) on another study on the same patient on the same date of service. Thus, when 95885 and 95886 are reported together, they must be accompanied with a modifier. The specific modifier required to comply with this NCCI edit will vary among payers.
Both codes should be reported once per extremity, and can be reported together up to a combined total of four units of service per patient when all four extremities are tested.
Also effective April 1, at least one Medicare carrier will begin requiring additional documentation for nerve conduction studies. According to a recently announced local coverage decision from TrailBlazer Health Enterprises, LLC, “payment for nerve conduction studies will require additional information be included on or with the claim.” This required information includes the manufacturer’s name as well as the model name of the equipment used for testing.
Visit the CMS website at www.cms.gov/medicare-coverage-database to find your Medicare carrier and the most recent coverage policies for your area. More information about this change and other diagnostic coding insights is available in the online webinar “CPT Coding for Neurodiagnostic Procedures Made Easy.” Visit www.aan.com/go/practice/coding/conferences to access this and other recordings or to register for upcoming practice management topics.