Medicare Denied 95903/95904 reason CO-4/M80

Hello,

Please need advise on this denials,our claims medicare denied in march and may CPT® 95903/95904 for bundle with 95861,so we rebilled with mod 59 all claims got paid and went smoothly,But its happening again that medicare denied 95903/95904,even they were billed with mod 59,they says bill with correct mod or send appeal for redetermination,please can any one advise on this

Regards

re: Medicare Denied 95903/95904 reason CO-4/M80

Here is the gudiance from Cahaba:

CPT® Codes 95900, 95903, 95904 - Nerve Conduction Studies
1. The CPT® codes 95900, 95903, and/or 95904 are used only once when multiple sites on the same nerve are stimulated or recorded.
2. To qualify as a study of two or more branches of a given motor, sensory, or mixed nerve, both the stimulating and recording electrodes must be moved to different locations; in which case, it is appropriate to bill for the number of multiple units of CPT® codes 95900-95904 performed.
3. Most nerves have a contralateral counterpart; bilateral testing is often necessary for comparison purposes. Nerves on each side may be billed separately. In addition, motor CPT® code 95900 or 95903, sensory CPT® code 95904, and mixed sensory CPT® code 95904 studies on an individual nerve are appropriately carried out and billed separately.
4. CPT® codes 95903 and 95900 may appropriately be billed together for the same patient on the same day when multiple nerves are tested, some with and some without F waves, since, in that case they describe distinct and independent services. However, CPT® codes 95903 and 95900 cannot be billed together for the same nerve in a given patient on a given day.
5. Testing the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla and supraclavicular regions will all be considered as a one-unit test of 95900 or 95904. Different methods of measuring the conduction in the same nerve will not be reimbursed as separate services.
G. CPT® Code 95903 - F-wave study
1. If a nerve conduction study with F-wave study is performed on a single motor nerve, report the service as 95903. If nerve conduction studies are performed on two different nerves, the first with F-wave study and the second nerve without F-wave study, the first nerve should be reported as 95903 and the second 95900. Append modifier 59 (Distinct Procedural Service) to indicate that a separate, distinct nerve was studied.
2. F-wave studies are billed in combination with the motor nerves that are examined (CPT® code 95903). Although the set-up for an F-wave study is similar to the set-up for a motor NCS, the testing is performed separately from motor NCSs, utilizing different machine settings and separate stimulation to obtain a larger number of responses (at least 10).
3. The table above summarizes the AANEM’s recommendations regarding a reasonable maximum number of studies per diagnostic category necessary for a physician to arrive at a diagnosis in 90% of patients with that final diagnosis.
4. The appropriate number of studies to be performed should be left to the judgment of the physician performing the electrodiagnostic evaluation. However, in the small number of cases which require testing in excess of the numbers listed in the table (the AANEM estimates 10% of cases), the physician should provide supplementary documentation to justify the additional testing.
5. If nephrologists submit 95900, 95903, 95904, 95934, or 95936 for ESRD, these codes are not separately payable; they are part of the monthly capitation fee. These codes are payable if submitted by other specialties when the indications are appropriate.

re: Medicare Denied 95903/95904 reason CO-4/M80

wow that was so long :) but to be honest we just need a advise from you that how we bill ?
95861
95903 mod 59
95904 mod 59
95937

above we bill but they denied CPT® 95903/04 asking correct modifier please help thank you

re: Medicare Denied 95903/95904 reason CO-4/M80

http://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31346_6/L31346_NEURO005_CBG_010112.pdf

re: Medicare Denied 95903/95904 reason CO-4/M80

thanks for helping me out but Iam still pioneer on this please advise how should i bill EMG services with correct mod thank you

re: Medicare Denied 95903/95904 reason CO-4/M80

Try KX as the modifier for 95900/95903/95904. I bill them and get paid for this. Also, make sure you have the make and model of the equipment used.

re: Medicare Denied 95903/95904 reason CO-4/M80

And, I'll add that there are no short cuts in coding. You have to take the time to read all of the detail so that you are sure you are submitting claims correctly.

I love these forums, but a brief question and an answer based on a brief description of your situation is not sufficient for you or your clinician. You must take the time to read the details.

re: Medicare Denied 95903/95904 reason CO-4/M80

KX is the mod? what is stand for and what does it mean?

re: Medicare Denied 95903/95904 reason CO-4/M80

http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-kx.shtml
Subsection D

re: Medicare Denied 95903/95904 reason CO-4/M80

Please explain If i want to bill 95861,95900,95903 and 95904 so what would the correct way,I mean how can i use KX mod with which code? garcias :)

re: Medicare Denied 95903/95904 reason CO-4/M80

In all due respect, you should read the guidance posted it is sufficient for you to review and evaluate based upon your documentation. There is no quick way to do this and the only way any of us learn is by doing the work, reading, researching and yes networking.