Medicare Carrier Drops Mandated Needle EMG

By News Staff
7/19/2007

Florida Medicare carrier First Coast Service Options Inc. recently published a final local coverage determination, or LCD, for electromyography and nerve conduction studies that gives physicians leeway to determine when to do both EMG and nerve conduction studies. Initially, the carrier had proposed that patients undergo both tests.

AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., had argued in a March 2 letter to the carrier's medical director that the proposed mandate would "effectively limit the performance of electrodiagnostic studies only to neurologists and physiatrists who primarily perform needle EMG (or nEMG) procedures."

The carrier's final LCD, which went into effect June 30, now carries the verbiage, "Both electromyography and nerve conduction studies are required for a clinical diagnosis of some peripheral nervous system disorders. In such instances when both procedures are needed, they should be performed together. In instances where only one study is to be performed, the rationale should be included in the clinical documentation."

In his letter, Fields said that mandating that nEMG studies be performed on all patients receiving a nerve conduction study was not clinically valid because the proposed policy

was not a present standard of care held anywhere in medicine;
was not supported by evidence-based guidelines; and
restricted the use of nerve conduction studies by family physicians, thereby limiting access to care for Medicare beneficiaries.

In addition, the Academy successfully persuaded the Medicare carrier to delete coding directions in its final LCD that required physicians to bill automated nerve conduction testing under CPT code 95999, an unlisted code, rather than codes 95900 to 95904.

An unlisted code is reported when no existing CPT code accurately describes a procedure.

"Unnecessary reporting with an unlisted code such as 95999 negatively impacts physicians by requiring submission of additional documentation, which creates an administrative burden for physicians and their staffs, and by delaying payment," said Fields, in his March letter. He requested that the carrier wait for forthcoming CPT editorial action -- expected in October -- on appropriate coding for nerve conduction tests.

The Academy has been tracking -- and fighting against -- mandated nEMGs in a number of states since the fall of 2006.

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