EMG Billing Question

[knoxdoc]

I know this isn't directly a pain issue, but does anyone know whether doing a median motor NCS and a median sensory NCS on the same limb should be billed as two studies or just one?

My confusion stems from wording from the AAN website. In bold it mentions that each NCS is billed only ONCE when multiple sites along the nerve are stimulated. Technically, you would be stimulating multiple sites on the median nerve when doing motor and sensory. Here is the quote from AAN:

Nerve conduction study codes 95900, 95903, 95904, and H–reflex codes95934 and 95936 have been deleted. Seven new nerve conduction codes (95907–95913) have been established. In the new coding structure, the unit of service in codes 95907–95913 is the number of nerve conduction studies performed; whereas the unit of service in previous codes 95900–95904 was each nerve. For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with an F–wave or without an F wave test, or an H–reflex test. Each type of nerve conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded. The numbers of these separate tests should be added to determine which code to use.

Thanks.

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[SSdoc33]

I know this isn't directly a pain issue, but does anyone know whether doing a median motor NCS and a median sensory NCS on the same limb should be billed as two studies or just one?

My confusion stems from wording from the AAN website. In bold it mentions that each NCS is billed only ONCE when multiple sites along the nerve are stimulated. Technically, you would be stimulating multiple sites on the median nerve when doing motor and sensory. Here is the quote from AAN:

Nerve conduction study codes 95900, 95903, 95904, and H–reflex codes95934 and 95936 have been deleted. Seven new nerve conduction codes (95907–95913) have been established. In the new coding structure, the unit of service in codes 95907–95913 is the number of nerve conduction studies performed; whereas the unit of service in previous codes 95900–95904 was each nerve. For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with an F–wave or without an F wave test, or an H–reflex test. Each type of nerve conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded. The numbers of these separate tests should be added to determine which code to use.

Thanks.

the language is ambiguous, but it is definitely 2 studies, not 1. it is only 1 study for mulitple sites along one motor nerve (like an ulnar inching study, for example)

 

[knoxdoc]

Thanks SS. The joke of it all is that adding another couple studies literally pays an extra $10 through medicare. EMG is not even remotely profitable now - I'm better off seeing 2-3 medicare rechecks.

 

[bedrock]

Thanks SS. EMG is not even remotely profitable now - I'm better off seeing 2-3 medicare rechecks.

Exactly. I saw this coming a year ago when they did the first bundling of EMG codes. I don't know how the wise captains of AANEM and AAPMR didn't????

I completely moved away from doing EMGs during the course of 2012, in lieu of other procedures which pay much better. So glad now.

Always hated doing EMGS before, but now that they pay worse than seeing medicare follow-ups, you'll never see me doing EMGs again.......

 

[nvrsumr]

Bedrock. I know we supposedly got a 57% cut thru bundling. I havent worked the math out yet.

What are you calculating the medicare payment for a unitlateral cts study (2 sensory, 2 motor, 1limb emg) will be now?

Im so glad I got "board certified" in edx.... What a waste.

 

[knoxdoc]

bedrock. I know we supposedly got a 57% cut thru bundling. I havent worked the math out yet.

What are you calculating the medicare payment for a unitlateral cts study (2 sensory, 2 motor, 1limb emg) will be now?

Im so glad i got "board certified" in edx.... What a waste.

$143.

 

[nvrsumr]

wow.

 

[SSdoc33]

if you werent in a bad mood before clicking on this link, you will be afterwards. deplorable.

http://www.aanem.org/Practice/Coding.aspx


way to go AANEM!!!! a 50% cut is ludicrous. i cant remember any procedure being cut so drastically in one year.

 

[SSdoc33]

or another one:

http://www.aan.com/go/practice/coding

 

[pmrmd]

And the physical therapy cap went up in October

 

[Dr. Ice]

And the physical therapy cap went up in October

So whats left...oh yeah..oxycontin and vicodin are still being paid

 

[bedrock]

if you werent in a bad mood before clicking on this link, you will be afterwards. deplorable.

http://www.aanem.org/Practice/Coding.aspx


way to go AANEM!!!! a 50% cut is ludicrous. i cant remember any procedure being cut so drastically in one year.

AANEM are a bunch of *****s. It was totally obvious after CMS did their first bit of EMG bundling for 2012, that they were getting ready to whack EMG big-time. I saw this coming and changed my practice by the end of 2012 to do other procedures instead of EMG.

How the hell didn't the AANEM see this coming, when it was clear as day to me?

 

[jsaul]

AANEM are a bunch of *****s. It was totally obvious after CMS did their first bit of EMG bundling for 2012, that they were getting ready to whack EMG big-time. I saw this coming and changed my practice by the end of 2012 to do other procedures instead of EMG.

How the hell didn't the AANEM see this coming, when it was clear as day to me?[/QUOTE]

so what were they going to do to make it different. there was nothing that could prevent this cut from happening. no matter how many letters aanem was going to send out to cms.

 

[Gauss]

so what is the value of aanem certification now? what relevance does aanem even have?

 

[jsaul]

so what is the value of aanem certification now? what relevance does aanem even have?

It was never of any value to get. It is a money making orginization. it is not an AMS board. it is an entity created to make money for itself...

 

[axm397]

we have stopped doing medicare EMGs in my practice.

AANEM, AAN, and AAPMR met with CMS on 12/20 for the last time to try to get this to stop. It all stems from the AMA RUC - CPT committee overriding the AAPMR, AAN, and AANEM concerns.


here's the timeline

https://www.aanem.org/Practice/Coding/Timeline.aspx

here's the panel: http://www.ama-assn.org/resources/doc/rbrvs/ruc-members-current.pdf

 

[specepic]

Botox for migraine took an even bigger cut. They created a new code 64615 that pays for ****. The cut is about 75 per cent from prior 64612 and 64613 comboto . While it overpaid a bit before (about 6 rvu's per session), not it pays 1.7 rvu's. ****! Used to be a great practice builder.

 

[bedrock]

Botox for migraine took an even bigger cut. They created a new code 64615 that pays for ****. The cut is about 75 per cent from prior 64612 and 64613 comboto . While it overpaid a bit before (about 6 rvu's per session), not it pays 1.7 rvu's. ****! Used to be a great practice builder.

That bites.

For me, Primary headache and/or EMGs now equal---"referral to neurology"

 

[mdvol]

Yeah I am now cherry picking EMG's and may just "specialize" in CTS eval with insurance. I really feel for my fellow PM&R folks who were really relying on EMG's. I maybe do 8/week. Pretty shrewd too how they grouped the nerve numbers.