Electrodiagnosticstudies are a commonly-used technique to test the function of muscles and nerves. Physicians order these studies to determine the cause of neck or back pain, numbness and tingling, and strength loss suffered by car accident victims. While physicians find that these studies are absolutely imperative to plan the future course of treatment for their patients, insurance companies consistently attempt to avoid payment by challenging medical necessity. Our no-fault billing and legal teams have the expertise to handle these challenges and recover payment for the performance of these studies.
An Overview of EMG-NCV Testing
Electromyogram (EMG) testing is used to measure and record the electrical activity of muscles. When the muscles are active, they produce an electrical current. This current is usually proportional to the level of the muscle activity.
EMGs are used to detect abnormal electrical activity that is present in many diseases and conditions. These include inflammation of muscles, pinched nerves, damaged nerves in the arms and legs, disc herniations, and degenerative diseases such as muscular dystrophy. EMGs allow physicians to distinguish between muscle conditions where the problem’s root is the muscle itself, and muscle weakness that is due to nerve disorders.
Nerve Conduction Velocity (NCV) testing if often performed at the same time as EMG testing. In this test, surface electrodes are placed on the patient’s skin to give off a mild electrical impulse. While one electrode stimulates a nerve, the other electrodes placed on the body detect the electrical activity resulting from the stimulation. The time it takes for electrical impulses to travel between electrodes is used to calculate the speed of nerve signals. A decreased speed may indicate nerve disease.
NCV testing can be used to detect true nerve disorders (such as neuropathy) or conditions where muscles are affected by nerve injury (such as carpal tunnel syndrome).
Medical Necessity of EMG-NCV Testing
EMG/NCV testing has long been acknowledged as an invaluable diagnostic tool that assists physicians in diagnosing the severity and extent of spinal injuries. The American Association of Electrodiagnostic Medicine has recognized that EMG/NCV testing is the gold standard in localizing nerve tensions as accurately as possible. Combining these tests with a detailed history and a physical exam, a physician is able to better predict the patient’s prognosis and determine the best course of treatment.
No-Fault Billing of EMG-NCV Studies
Our no-fault billing experts keep up to date with the latest changes in billing codes for EMG-NCV testing. The following are common CPT codes used for billing of EMG-NCV studies (effective June 1, 2012):
95885: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure). Relative Value: 11.66
95886: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, 5 or more muscles studied, innervated by 3 or more nerves or 4 or more spinal levels (List separately in addition to code for primary procedure). Relative Value: 18.27
95887: Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure). Relative Value: 16.28
As of January 1, 2013, CPT codes 95900, 95903, 95934 and 95904 have been deleted and bills will no longer need to differentiate between the type of nerve conduction studies performed. The requirements now are to count the number of studies and choose the corresponding code. The new codes are as follows:
95907: Nerve conduction studies; 1-2 studies.
95908: Nerve conduction studies; 3-4 studies.
95909: Nerve conduction studies; 5-6 studies.
95910: Nerve conduction studies; 7-8 studies.
95911: Nerve conduction studies; 9-10 studies.
95912: Nerve conduction studies; 11-12 studies.
95913: Nerve conduction studies; 13 or more studies.
For more information about how to properly bill EMG-NCV studies, call us at (516) 427-5400 for a complimentary consultation.
The Point of View of No-Fault Insurance Carriers about EMG / NCV
Due to the comparatively high reimbursement afforded to physicians for administering electrodiagnostic testing, insurance companies consistently attempt to undermine a treating physician’s recommendation that his or her patients received EMG and/or NCV testing.
This is done most commonly in the form of an insurance company-paid peer review. The insurance company’s peer reviewer denies the medically necessity of the testing based on a boilerplate rationale, for example;
1, The EMG-NCV test results would not have affected treatment;
2, Radiculopathy can be diagnosed clinically;
3, An EMG/NCV test cannot rule out radiculopathy.
Fortunately, for physicians and car accident victims, these and other boilerplate arguments against the use of electrodiagnostic studies are routinely rejected by judges and arbitrators as insufficient as a matter of laws
Disclaimer: Please be advised that the purpose of this information about EMG / NCV medical procedure is none other than to make the reader aware that at No-Fault Billing.com we are experts in no-fault billing and collection. At no time this information should be used for any other purpose. Its solely the responsibility of the treating physician to determine which medical procedure is medically necessary and justify such medical necessity. Numbers of nerves to be Tested in EMG / NCV are also sole decision of the treating physician. This information should never be used by any physician to plan or administer any medical treatment.
You are entitled to recover money for the medical services you render to your patients. To learn more from us about EMG-NCV billing, please call (516) 427-5400 for an immediate, free consultation.