LCD for Nerve Conduction Studies (NCS)/Electromyography (EMG) (L26869) Contractor Information

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "LCD for Nerve Conduction Studies (NCS)/Electromyography (EMG) (L26869) Contractor Information"

Transcription

1 Page 1 of 24 Deborah Rondeau From: Saved by Windows Internet Explorer 7 Sent: Saturday, August 23, :49 PM Subject: FUTURE LCD : Nerve Conduction Studies (NCS)/Electromyography (EMG) (L26869) LCD for Nerve Conduction Studies (NCS)/Electromyography (EMG) (L26869) Contractor Information Contractor Name National Government Services, Inc. Contractor Number Number Type State(s) FI IN FI IL FI KY FI ME FI MA FI NH, VT FI CT, DE, NY FI OH FI WI FI MI FI VA, WV Carrier IN Carrier KY Carrier NJ MAC CT Part A MAC CT Part B MAC NY Part A MAC NY Part B MAC NY- Part B MAC NY Part B Contractor Type Carrier FI MAC Part A MAC Part B LCD Information LCD ID Number

2 Page 2 of 24 L26869 LCD Title Nerve Conduction Studies (NCS)/Electromyography (EMG) Contractor's Determination Number L26869 (R1) AMA CPT / ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR [b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act. Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: Title XVIII of the Social Security Act (SSA): Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Balanced Budget Act of 1997, Chapter 1, Section 4317.b. indicates that diagnostic information must be provided by the ordering physician or practitioner to allow payment to be made to the performing entity. Code of Federal Regulations: 42 CFR Section indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who uses the results in the management of the beneficiary s specific medical problem.

3 Page 3 of 24 Federal Register: Federal Register Vol. 62, 59047, Supervision of Diagnostic Tests, describes the degree of physician supervision required for diagnostic tests. CMS Publications: Pub , Medicare National Coverage Determinations, Chapter 1, Part 2: Sensory Nerve Conduction Threshold Tests (sncts) Primary Geographic Jurisdiction Number Type State(s) FI IN FI IL FI KY FI ME FI MA FI NH, VT FI CT, DE, NY FI OH FI WI FI MI FI VA, WV Carrier IN Carrier KY Carrier NJ MAC CT Part A MAC CT Part B MAC NY Part A MAC NY Part B MAC NY- Part B MAC NY Part B Secondary Geographic Jurisdiction See Other Comments Oversight Region CMS Region I, II, III, V Original Determination Effective Date For services performed on or after 07/01/2008 Original Determination Ending Date Not applicable

4 Page 4 of 24 Revision Effective Date For services performed on or after 07/18/2008 Revision Ending Date Not applicable Indications and Limitations of Coverage and/or Medical Necessity This LCD consolidates and replaces all previous policies and publications on this subject by the carrier and fiscal intermediary predecessors of National Government Services (AdminaStar Federal, Anthem Health Plans of New Hampshire, Associated Hospital Service, Empire Medicare Services, Group Health Incorporated (GHI), HealthNow, First Coast Service Options, and United Government Services). This revised LCD is effective for all National Government Services jurisdictions on July 18, 2008 with these exceptions: for Connecticut Part B the LCD is effective on August 1, 2008; for Upstate New York Part B, the LCD is effective on September 1, 2008; and for New York and Connecticut Part A, the LCD is effective on November 14, For New York Part A (contract 00308), the content of this LCD is currently in effect but the LCD will be transferred to the J-13 contract number on November 14, Abstract: The electrodiagnostic evaluation is an extension of the neurologic portion of the physical examination. Both require a detailed knowledge of a patient and his/her disease. Training in the performance of electrodiagnostic procedures in isolation of knowledge about clinical diagnostic and management aspects of neuromuscular diseases, may not be adequate for proper performance of an electrodiagnostic evaluation and correct interpretation of electrodiagnostic test results. Without awareness of the patterns of abnormality expected in different diseases and knowledge that the results of nerve conduction studies (NCS) and electromyography (EMG) may be similar in different diseases, diagnosis solely by EMG-NCS findings may be both inadequate and ultimately be detrimental to the patient. Guidelines about proper qualifications for qualified health care professionals performing electrodiagnostic evaluations have been developed and published by AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine) and other medical organizations, including the AMA, the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation, American Neurological Association, the American Board of Physical Therapy Specialists in Neurophysiology, and the Department of Veterans Affairs. These guidelines will be considered by National Government Services when evaluating a health care professional as qualified to perform nerve conduction studies and electromyography. Both EMGs and NCSs are usually required for a clinical diagnosis of peripheral nervous system disorders. Performance of one type of testing does not eliminate the need for the other. The intensity and extent of testing with EMG and NCS are matters of clinical judgment developed after the initial pre-test evaluation, and later modified during the testing procedure.

5 Page 5 of 24 Decisions to continue, modify or conclude a testing rely on knowledge of anatomy, physiology and neuromuscular diseases. Ongoing real-time assessment of data is required during the clinical diagnostic evaluation and especially during EMG examination. Nerve conduction studies (NCS) are used to measure action potentials resulting from peripheral nerve stimulation which are recordable over the nerve or from an innervated muscle. With this technique, responses are measured between two sites of stimulation, or between a stimulus and a recording site. Nerve conduction studies are of two general types: sensory and motor. Either surface or needle electrodes can be used to stimulate the nerve or record the response. Axonal damage or dysfunction generally results in loss of nerve or muscle potential response amplitude; whereas, demyelination leads to prolongation of conduction time and slowing of conduction velocity. Obtaining and interpreting NCS results requires extensive interaction between the performing qualified health care professional and patient, and is most effective when both obtaining raw data and interpretation are performed concurrently on a real-time basis. Results of the NCS reflect on the integrity and function of: (I) the myelin sheath (Schwann cell derived insulation covering an axon), and (II) the axon (an extension of neuronal cell body) of a nerve. Interruption of axon and dysfunction of myelin will both affect NCS results. It is often also valuable to test conduction status in proximal segments of peripheral nerves. This assessment can be accomplished by H-reflex, F-wave and blink reflex testing. These proximal segments include the first several centimeters of a compound nerve emerging from the spinal cord or brainstem. H-reflex, F-waves and Blink reflex testing (CPT 95934, 95936, 95903, 95933) accomplish this task better than distal NCS (CPT 95900, 95904). Electromyography (EMG) is the study and recording of intrinsic electrical properties of skeletal muscles. This is carried out with a needle electrode. Generally, the electrodes are of two types: monopolar or concentric. EMG is undertaken together with NCS. Unlike NCS, however, EMG testing relies on both auditory and visual feedback to the electromyographer. This testing is also invasive in that it requires needle electrode insertion and adjustment at multiple sites, and at times anatomically critical sites. As in NCS during EMG studies the electromyographer depends on ongoing real-time interpretation based knowledge of clinical diagnosis being c evaluated to decide whether to continue, modify, or conclude a test. This process requires knowledge of anatomy, physiology, and neuromuscular diseases. EMG results reflect not only on the integrity of the functioning connection between a nerve and its innervated muscle but also on the integrity of a muscle itself. The axon innervating a muscle is primarily responsible for the muscle s volitional contraction, survival, and trophic functions. Thus, interruption of the axon will alter the EMG. A few prime examples of conditions in which EMG is potentially helpful are disc disease producing spinal nerve dysfunction, advanced nerve compression in peripheral lesions,

6 Page 6 of 24 ALS, polyneuropathy, etc. After an acute neurogenic lesion, EMG changes may not appear for several days to weeks in the innervated muscles. Primary muscle disease such as polymyositis will also alter a normal EMG pattern. Myotonic disorders may show a pattern of spontaneous repetitive discharges on needle exploration. In summary, axonal and muscle involvement are most sensitively detected by EMGs, and myelin and axonal involvement are best detected by NCSs. Indications: Nerve conduction studies (CPT Codes 95900, 95903, 95904, 95933, 95934, 95936) NCS may be helpful in the diagnosis of carpal tunnel syndrome, ulnar neuropathy at the elbow and peripheral polyneuropathies, traumatic nerve damage, and neuromuscular junction disorders like myasthenia gravis. NCS may be indicated in the following clinical scenarios: Focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies or root lesions, for localization Traumatic nerve lesions, for diagnosis and prognosis Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic or immune Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome Symptom-based presentations such as pain in limb, weakness, disturbance in skin sensation or paraesthesia when appropriate pre-test evaluations are inconclusive and the clinical assessment unequivocally supports the need for the study The clinical history and examination, carried out before the study, must always describe and document clearly and comprehensibly the need for the planned test, and what the results are expected to contribute that is medically necessary for the ordering physician to diagnose or treat the illness or injury or improve the functioning of a malformed body member. Electromyography (CPT Codes 92265, 95860, 95861, 95863, 95864, 95867, 95868, 95869, 95870, 95872) The presence of damage to the motor nerve cell bodies and peripheral axons is detected by a carefully performed EMG. Neurogenic disorders are distinguishable from myopathic disorders by EMG testing. Below is a list of common disorders in which EMG, in tandem with properly conducted NCS, will be helpful in diagnosis: Nerve compression syndromes, including carpal tunnel syndrome and other focal compressions Radiculopathy-cervical, lumbosacral

7 Page 7 of 24 Polyneuropathy-metabolic, degenerative, hereditary Plexopathy-idiopathic, trauma, infiltration Myopathy-including poly and dermatomyositis, myotonic and congenital myopathies Neuromuscular junction disorders-myasthenia gravis (The advance technique of Single fiber EMG is of especial value here.) At times, immediately prior to Botulinum A toxin injection, for muscle localization At times, immediately prior to injection of phenol or other substances for nerve blocking or chemodenervation for muscle localization Limitations: Nerve Conduction Studies Each descriptor (code) can be reimbursed only once per nerve, or named branch of a nerve, regardless of the number of sites tested or the number of methods used on that nerve. For instance, testing the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla and supraclavicular regions will all be considered as a single unit test of code or Motor and sensory nerve testing are considered separate tests. Sensory nerve testing should be reported using CPT code For sensory nerve testing by either the orthodromic and antidromic methods, only one unit of charge will be paid when the same nerve is evaluated by these different methods. Screening testing for polyneuropathy of diabetes or endstage renal disease (ESRD) is NOT covered. Testing for the sole purpose of monitoring disease intensity or treatment efficacy in these two conditions is also not covered. Psychophysical measurements (current, vibration, thermal perceptions), even though they may involve delivery of a stimulus, are not covered. Current Perception Threshold/Sensory Nerve Conduction Threshold Test (snct) is not covered by Medicare. This procedure is different and distinct from assessment of nerve conduction velocity, amplitude and latency. It is also different from short-latency somatosensory evoked potentials. Codes designated for eliciting nerve conduction velocity, latency or amplitude, and those designed for short latency evoked potentials are not to be used for snct. The snct has a unique code. Include the code here. Effective October 1, 2002, CMS initially concluded that there was insufficient scientific or clinical evidence to consider the snct test and the device used in performing this test reasonable and necessary within the meaning of section 1862(a)(1)(A) of the law. Therefore, snct was noncovered. Based on a reconsideration [in March, 2004] of current Medicare policy for snct, CMS concludes that there continues to be insufficient scientific or clinical evidence to consider the snct test and the device used in performing this test as reasonable and necessary within the meaning of section 1862(a) (1)(A) of the law. CMS Publication 100-3, Medicare National Coverage Issues Manual, Chapter 1, Section Examination using portable hand-held devices, which are incapable of real-time waveform display and analysis, will be included in the E/M service. They will not be paid

8 Page 8 of 24 separately. Nerve conduction studies must provide a number of response parameters in a real-time fashion to facilitate provider interpretation. Those parameters include amplitude, latency, configuration and conduction velocity. Medicare does not accept diagnostic studies that do not provide this information or those that provide delayed interpretation as substitutes for Nerve conduction studies. Raw measurement data obtained and transmitted trans-telephonically or over the Internet, therefore, does not qualify for the payment of the electrodiagnostic service codes included in this LCD. Medicare does not expect to receive claims for nerve conduction testing accomplished with discriminatory devices that use fixed anatomic templates and computer-generated reports used as an adjunct to physical examination routinely on all patients. Electromyography It is expected that providers will use CPT code for sampling muscles other than the paraspinals associated with the extremities, which have been tested. Medicare would not expect to see this code billed when the paraspinal muscles corresponding to an extremity are tested and when the extremity EMG code 95860, 95861, or is also billed. The necessity and reasonableness of the following uses of EMG studies have not been established: exclusive testing of intrinsic foot muscles in the diagnosis of proximal lesions definitive diagnostic conclusions based on paraspinal EMG in regions bearing scar of past surgeries (e.g., previous laminectomies) pattern-setting limited limb muscle examinations, without paraspinal muscle testing for a diagnosis of radiculopathy EMG testing shortly after trauma, before EMG abnormalities would have reasonably had time to develop surface and macro EMG s multiple uses of EMG in the same patient at the same location of the same limb for the purpose of optimizing botulinum toxin injections. Other Comments: For claims submitted to the fiscal intermediary: This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated National Government Services to process their claims. Bill type codes only apply to providers who bill these services to the fiscal intermediary. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier. Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must

9 Page 9 of 24 notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes. For outpatient settings other than CORFs, references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order and establish the plan of care for NCS/EMG services as authorized by State law. (See Sections 1861[s][2] and 1862[a][14] of Title XVIII of the Social Security Act; 42 CFR, Sections , , and ; 58 FR 18543, April 7, 2000.) Each practitioner must provide only those service within the scope of practice for each state, e.g., in the state of New Jersey only a physician may perform EMG studies. Coverage Topic Diagnostic Tests and X-Rays Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 12x 13x Hospital-inpatient or home health visits (Part B only) Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) 21x SNF-inpatient, Part A 22x SNF-inpatient or home health visits (Part B only) 23x SNF-outpatient (HHA-A also) 71x Clinic-rural health 85x Special facility or ASC surgery-rural primary care hospital (eff 10/94) Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported

10 Page 10 of 24 under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. Revenue codes only apply to providers who bill these services to the fiscal intermediary. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier. Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes Other diagnostic services-general classification 0922 Other diagnostic services-electromyelogram 0929 Other diagnostic services-other CPT/HCPCS Codes Nerve Conduction Studies (NCS) NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; MOTOR, WITHOUT F-WAVE STUDY NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; MOTOR, WITH F-WAVE STUDY NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; SENSORY ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN GASTROCNEMIUS/SOLEUS MUSCLE G0255 CURRENT PERCEPTION THRESHOLD/SENSORY NERVE CONDUCTION TEST, (SNCT) PER LIMB, ANY NERVE Electromyography (EMG) NEEDLE ELECTROMYOGRAPHY; ONE EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS NEEDLE ELECTROMYOGRAPHY; TWO EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS NEEDLE ELECTROMYOGRAPHY; THREE EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS NEEDLE ELECTROMYOGRAPHY; FOUR EXTREMITIES WITH OR WITHOUT

11 Page 11 of 24 RELATED PARASPINAL AREAS NEEDLE ELECTROMYOGRAPHY; LARYNX NEEDLE ELECTROMYOGRAPHY; HEMIDIAPHRAGM NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLE(S), UNILATERAL NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES (EXCLUDING T1 OR T12) NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN ONE EXTREMITY OR NON-LIMB (AXIAL) MUSCLES (UNILATERAL OR BILATERAL), OTHER THAN THORACIC PARASPINAL, CRANIAL NERVE SUPPLIED MUSCLES, OR SPHINCTERS NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE MEASUREMENT OF JITTER, BLOCKING AND/OR FIBER DENSITY, ANY/ALL SITES OF EACH MUSCLE STUDIED ICD-9 Codes that Support Medical Necessity It is the responsibility of the provider to code to the highest level specified in the ICD- 9-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. 138 LATE EFFECTS OF ACUTE POLIOMYELITIS MALIGNANT NEOPLASM OF CRANIAL NERVES MALIGNANT NEOPLASM OF CEREBRAL MENINGES MALIGNANT NEOPLASM OF SPINAL CORD MALIGNANT NEOPLASM OF SPINAL MENINGES SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD SECONDARY MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED BENIGN NEOPLASM OF CRANIAL NERVES BENIGN NEOPLASM OF SPINAL CORD BENIGN NEOPLASM OF OTHER SPECIFIED SITES OF NERVOUS SYSTEM DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR

12 Page 12 of 24 UNSPECIFIED TYPE, UNCONTROLLED DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED OTHER AND UNSPECIFIED MANIFESTATIONS OF THIAMINE DEFICIENCY DEFICIENCY OF OTHER VITAMINS LIPOPROTEIN DEFICIENCIES GENETIC TORSION DYSTONIA ATHETOID CEREBRAL PALSY OTHER ACQUIRED TORSION DYSTONIA BLEPHAROSPASM OROFACIAL DYSKINESIA SPASMODIC TORTICOLLIS ORGANIC WRITERS' CRAMP OTHER FRAGMENTS OF TORSION DYSTONIA HEREDITARY SPASTIC PARAPLEGIA WERDNIG-HOFFMANN DISEASE SPINAL MUSCULAR ATROPHY UNSPECIFIED KUGELBERG-WELANDER DISEASE OTHER SPINAL MUSCULAR ATROPHY AMYOTROPHIC LATERAL SCLEROSIS PROGRESSIVE MUSCULAR ATROPHY PROGRESSIVE BULBAR PALSY PSEUDOBULBAR PALSY PRIMARY LATERAL SCLEROSIS OTHER MOTOR NEURON DISEASES OTHER ANTERIOR HORN CELL DISEASES ANTERIOR HORN CELL DISEASE UNSPECIFIED SYRINGOMYELIA AND SYRINGOBULBIA VASCULAR MYELOPATHIES SUBACUTE COMBINED DEGENERATION OF SPINAL CORD IN DISEASES CLASSIFIED ELSEWHERE MYELOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE OTHER MYELOPATHY UNSPECIFIED DISEASE OF SPINAL CORD IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY PERIPHERAL AUTONOMIC NEUROPATHY IN DISORDERS CLASSIFIED

13 Page 13 of 24 ELSEWHERE REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE AUTONOMIC DYSREFLEXIA UNSPECIFIED DISORDER OF AUTONOMIC NERVOUS SYSTEM SCHILDER'S DISEASE ACUTE (TRANSVERSE) MYELITIS NOS ACUTE (TRANSVERSE) MYELITIS IN CONDITIONS CLASSIFIED ELSEWHERE IDIOPATHIC TRANSVERSE MYELITIS OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM CONGENITAL DIPLEGIA CONGENITAL HEMIPLEGIA CONGENITAL QUADRIPLEGIA CONGENITAL MONOPLEGIA INFANTILE HEMIPLEGIA OTHER SPECIFIED INFANTILE CEREBRAL PALSY INFANTILE CEREBRAL PALSY UNSPECIFIED QUADRIPLEGIA UNSPECIFIED - QUADRIPLEGIA C5-C7 INCOMPLETE OTHER QUADRIPLEGIA PARAPLEGIA DIPLEGIA OF UPPER LIMBS MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE UNSPECIFIED MONOPLEGIA CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER OTHER SPECIFIED PARALYTIC SYNDROME PARALYSIS UNSPECIFIED ATYPICAL FACE PAIN BELL'S PALSY OTHER FACIAL NERVE DISORDERS FACIAL NERVE DISORDER UNSPECIFIED

14 Page 14 of DISORDERS OF PNEUMOGASTRIC (10TH) NERVE DISORDERS OF ACCESSORY (11TH) NERVE DISORDERS OF HYPOGLOSSAL (12TH) NERVE MULTIPLE CRANIAL NERVE PALSIES BRACHIAL PLEXUS LESIONS LUMBOSACRAL PLEXUS LESIONS CERVICAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED THORACIC ROOT LESIONS NOT ELSEWHERE CLASSIFIED LUMBOSACRAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED NEURALGIC AMYOTROPHY OTHER NERVE ROOT AND PLEXUS DISORDERS UNSPECIFIED NERVE ROOT AND PLEXUS DISORDER CARPAL TUNNEL SYNDROME OTHER LESION OF MEDIAN NERVE LESION OF ULNAR NERVE LESION OF RADIAL NERVE CAUSALGIA OF UPPER LIMB MONONEURITIS MULTIPLEX OTHER MONONEURITIS OF UPPER LIMB MONONEURITIS OF UPPER LIMB UNSPECIFIED LESION OF SCIATIC NERVE MERALGIA PARESTHETICA OTHER LESION OF FEMORAL NERVE LESION OF LATERAL POPLITEAL NERVE LESION OF MEDIAL POPLITEAL NERVE TARSAL TUNNEL SYNDROME LESION OF PLANTAR NERVE CAUSALGIA OF LOWER LIMB OTHER MONONEURITIS OF LOWER LIMB MONONEURITIS OF LOWER LIMB UNSPECIFIED MONONEURITIS OF UNSPECIFIED SITE HEREDITARY PERIPHERAL NEUROPATHY PERONEAL MUSCULAR ATROPHY HEREDITARY SENSORY NEUROPATHY REFSUM'S DISEASE IDIOPATHIC PROGRESSIVE POLYNEUROPATHY

15 Page 15 of OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY ACUTE INFECTIVE POLYNEURITIS POLYNEUROPATHY IN COLLAGEN VASCULAR DISEASE POLYNEUROPATHY IN DIABETES POLYNEUROPATHY IN MALIGNANT DISEASE POLYNEUROPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE ALCOHOLIC POLYNEUROPATHY POLYNEUROPATHY DUE TO DRUGS POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS CRITICAL ILLNESS POLYNEUROPATHY OTHER INFLAMMATORY AND TOXIC NEUROPATHY MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE TOXIC MYONEURAL DISORDERS OTHER SPECIFIED MYONEURAL DISORDERS MYONEURAL DISORDERS UNSPECIFIED CONGENITAL HEREDITARY MUSCULAR DYSTROPHY HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY MYOTONIC MUSCULAR DYSTROPHY PERIODIC PARALYSIS TOXIC MYOPATHY MYOPATHY IN ENDOCRINE DISEASES CLASSIFIED ELSEWHERE SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE CRITICAL ILLNESS MYOPATHY OTHER MYOPATHIES MYOPATHY UNSPECIFIED MYOPATHY OF EXTRAOCULAR MUSCLES ESOTROPIA UNSPECIFIED - ALTERNATING ESOTROPIA WITH OTHER NONCOMITANCIES EXOTROPIA UNSPECIFIED - ALTERNATING EXOTROPIA WITH OTHER NONCOMITANCIES INTERMITTENT HETEROTROPIA UNSPECIFIED - INTERMITTENT EXOTROPIA ALTERNATING

16 Page 16 of HETEROTROPIA UNSPECIFIED - ACCOMMODATIVE COMPONENT IN ESOTROPIA HETEROPHORIA UNSPECIFIED - ALTERNATING HYPERPHORIA PARALYTIC STRABISMUS UNSPECIFIED - TOTAL OPHTHALMOPLEGIA MECHANICAL STRABISMUS UNSPECIFIED - LIMITED DUCTION ASSOCIATED WITH OTHER CONDITIONS DUANE'S SYNDROME - STRABISMUS IN OTHER NEUROMUSCULAR DISORDERS PALSY OF CONJUGATE GAZE - OTHER DISSOCIATED DEVIATION OF EYE MOVEMENTS UNSPECIFIED DISORDER OF EYE MOVEMENTS ORTHOSTATIC HYPOTENSION LARYNGEAL SPASM ANAL SPASM DERMATOMYOSITIS POLYMYOSITIS EOSINOPHILIA MYALGIA SYNDROME CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY CERVICAL SPONDYLOSIS WITH MYELOPATHY THORACIC SPONDYLOSIS WITHOUT MYELOPATHY LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY SPONDYLOSIS WITH MYELOPATHY THORACIC REGION SPONDYLOSIS WITH MYELOPATHY LUMBAR REGION DISPLACEMENT OF CERVICAL INTERVERTEBRAL DISC WITHOUT MYELOPATHY DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT MYELOPATHY DISPLACEMENT OF THORACIC INTERVERTEBRAL DISC WITHOUT MYELOPATHY DISPLACEMENT OF INTERVERTEBRAL DISC SITE UNSPECIFIED WITHOUT MYELOPATHY DEGENERATION OF CERVICAL INTERVERTEBRAL DISC DEGENERATION OF THORACIC OR THORACOLUMBAR INTERVERTEBRAL DISC DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL DISC DEGENERATION OF INTERVERTEBRAL DISC SITE UNSPECIFIED INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY UNSPECIFIED REGION

17 Page 17 of INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY CERVICAL REGION INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY THORACIC REGION INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY LUMBAR REGION POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION POSTLAMINECTOMY SYNDROME OF CERVICAL REGION POSTLAMINECTOMY SYNDROME OF THORACIC REGION POSTLAMINECTOMY SYNDROME OF LUMBAR REGION OTHER AND UNSPECIFIED DISC DISORDER OF CERVICAL REGION OTHER AND UNSPECIFIED DISC DISORDER OF THORACIC REGION OTHER AND UNSPECIFIED DISC DISORDER OF LUMBAR REGION SPINAL STENOSIS IN CERVICAL REGION BRACHIAL NEURITIS OR RADICULITIS NOS TORTICOLLIS UNSPECIFIED SPINAL STENOSIS OF UNSPECIFIED REGION SPINAL STENOSIS OF THORACIC REGION SPINAL STENOSIS OF LUMBAR REGION SPINAL STENOSIS OF OTHER REGION PAIN IN THORACIC SPINE LUMBAGO SCIATICA THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS UNSPECIFIED BACKACHE UNSPECIFIED INFECTIVE MYOSITIS SPASM OF MUSCLE MUSCLE WEAKNESS (GENERALIZED) UNSPECIFIED DISORDER OF MUSCLE LIGAMENT AND FASCIA NEURALGIA NEURITIS AND RADICULITIS UNSPECIFIED PAIN IN LIMB OTHER MUSCULOSKELETAL SYMPTOMS REFERABLE TO LIMBS WRIST DROP (ACQUIRED) CLAW HAND (ACQUIRED) OTHER ACQUIRED DEFORMITIES OF FOREARM EXCLUDING FINGERS OTHER ACQUIRED DEFORMITIES OF ANKLE AND FOOT

18 Page 18 of TRANSIENT PARALYSIS OF LIMB TETANY DISTURBANCE OF SKIN SENSATION OTHER VOICE DISTURBANCE RETENTION OF URINE UNSPECIFIED INCOMPLETE BLADDER EMPTYING OTHER SPECIFIED RETENTION OF URINE URGE INCONTINENCE URINARY FREQUENCY C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED C1-C4 LEVEL WITH COMPLETE LESION OF SPINAL CORD C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME C1-C4 LEVEL WITH CENTRAL CORD SYNDROME C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY C5-C7 LEVEL SPINAL CORD INJURY UNSPECIFIED C5-C7 LEVEL WITH COMPLETE LESION OF SPINAL CORD C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME C5-C7 LEVEL WITH CENTRAL CORD SYNDROME C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED T1-T6 LEVEL WITH COMPLETE LESION OF SPINAL CORD T1-T6 LEVEL WITH ANTERIOR CORD SYNDROME T1-T6 LEVEL WITH CENTRAL CORD SYNDROME T1-T6 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY T7-T12 LEVEL SPINAL CORD INJURY UNSPECIFIED T7-T12 LEVEL WITH COMPLETE LESION OF SPINAL CORD T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME T7-T12 LEVEL WITH CENTRAL CORD SYNDROME T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY LUMBAR SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY SACRAL SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY CAUDA EQUINA SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY UNSPECIFIED SITE OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY

19 Page 19 of INJURY TO CERVICAL NERVE ROOT INJURY TO DORSAL NERVE ROOT INJURY TO LUMBAR NERVE ROOT INJURY TO SACRAL NERVE ROOT INJURY TO BRACHIAL PLEXUS INJURY TO LUMBOSACRAL PLEXUS INJURY TO MULTIPLE SITES OF NERVE ROOTS AND SPINAL PLEXUS INJURY TO UNSPECIFIED SITE OF NERVE ROOTS AND SPINAL PLEXUS INJURY TO CERVICAL SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES INJURY TO OTHER SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES INJURY TO OTHER SPECIFIED NERVE(S) OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES INJURY TO UNSPECIFIED NERVE OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES INJURY TO AXILLARY NERVE INJURY TO MEDIAN NERVE INJURY TO ULNAR NERVE INJURY TO RADIAL NERVE INJURY TO MUSCULOCUTANEOUS NERVE INJURY TO CUTANEOUS SENSORY NERVE UPPER LIMB INJURY TO DIGITAL NERVE UPPER LIMB INJURY TO OTHER SPECIFIED NERVE(S) OF SHOULDER GIRDLE AND UPPER LIMB INJURY TO MULTIPLE NERVES OF SHOULDER GIRDLE AND UPPER LIMB INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB INJURY TO SCIATIC NERVE INJURY TO FEMORAL NERVE INJURY TO POSTERIOR TIBIAL NERVE INJURY TO PERONEAL NERVE INJURY TO CUTANEOUS SENSORY NERVE LOWER LIMB INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB

20 Page 20 of INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB INJURY TO SUPERFICIAL NERVES OF HEAD AND NECK INJURY TO OTHER SPECIFIED NERVE(S) INJURY TO MULTIPLE NERVES IN SEVERAL PARTS INJURY TO NERVES UNSPECIFIED SITE Diagnoses that Support Medical Necessity Not applicable ICD-9 Codes that DO NOT Support Medical Necessity Not applicable ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation Diagnoses that DO NOT Support Medical Necessity Not applicable General Information Documentation Requirements The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. The clinical history and examination, carried out before the study, must always describe and document clearly and comprehensibly, the need for the planned test. Documentation should include patient history for sensory and/or motor nerve dysfunction. The patient's medical records must clearly document the medical necessity of the test and the type of test to be performed. It is not necessary to include documentation with each claim submission. Data gathered during NCS, however, should be available. It should reflect the actual numbers (latency, amplitude, etc.), preferably in a tabular (not narrative) format. Credentials of providers billing for needle electromyography must be available on request. The reason for referral and a clear interpretation are required for each study. Hard copies of wave forms obtained should be available. If hard copies are not available, a detailed report may be acceptable.

21 Page 21 of 24 There must be documentation justifying the study. National Government Services recognizes that the provider that ordered the test is often not the person who interprets the test. Diagnostic tests, as EMG and NCS, may have been ordered by a treating clinician, but performed and interpreted by another qualified health care professionals. In situations like this where two separate entities provide patient care, the onus of providing, obtaining and maintaining documentation does not rest in the exclusive domain of one or the other entity. Both the ordering and testing qualified health care professionals have this responsibility. In order to render good patient care and to receive Medicare payment, documentation is a basic prerequisite. Section 4317 of the Balanced Budget Act (BBA: SEC REQUIREMENT TO FURNISH DIAGNOSTIC INFORMATION) addresses this situation: When a test is, "...ordered by a physician or a practitioner specified in subsection (b) (18)(C), but furnished by another entity, if the Secretary (or fiscal agent of the Secretary) requires the entity furnishing the item or service to provide diagnostic or other medical information in order for payment to be made to the entity, the physician or practitioner shall provide that information to the entity at the time that the item or service is ordered by the physician or practitioner." Certain less than optimal practices are discouraged, and may invite reviews. They are: narrative reports alluding to "normal" or "abnormal" results without numerical data; descriptions of F-wave without reference to a corresponding motor conduction data; pattern-setting unilateral H-reflex measurements or separate E/M consultation charges without documentable request from the referral source. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act. Documentation must be available to Medicare upon request. Appendices Not applicable Utilization Guidelines Excessive use of units of testing (see table immediately below, based on a White Paper prepared by the American Association of Electrodiagnostic Medicine on suggested upper limits for CPT ) will be considered not medically necessary. Consistent repeated testing on the same patient, or testing every patient referred for pain, weakness or paresthesia may become evident on review. In such cases, the claim will considered not medically necessary. The NCS-EMG performing provider, in consultation with the referring provider, is responsible for determination of the appropriateness of a study.

22 Page 22 of 24 Conditions Motor NCV (CPT code 95900) Sensory NCV (CPT code 95904) Carpal Tunnel (unilateral) 3 4 Carpal Tunnel (bilateral) 4 6 Radioculopathy 3 2 Mononeuropathy 3 3 Polyneuropathy 4 4 Myopathy 2 2 ALS 4 2 Plexopathy Neuromuscular junction disorder Testing of the contralateral limb must be supported by medical necessity. Sources of Information and Basis for Decision This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below. AANEM Position Statement, Muscle Nerve 33: , 2006 AANEM Practice Topics, September, 2006 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Recommended Policy for Electrodiagnostic Medicine Brown Elizabeth, MD, An Evidence Based Technology Assessment of the NC-stat Device; March 19, 2007 Morse, Josh, NC-stat System, NeuroMetrix Inc. (Nerve Conduction Testing System) Technology Assessment: June 8, Other Contractor Local Coverage Determinations Stalberg, Erdem; Nerve Conduction Studies; The Online Journal of Neurological Sciences: 17 (2), Advisory Committee Meeting Notes Carrier Advisory Committee Meeting Date(s):

23 Page 23 of 24 Indiana 02/04/2008 Kentucky 02/07/2008 New Jersey 02/06/2008 New York 01/30/2008 This coverage determination does not reflect the sole opinion of the contractor or contractor Medical Director. Although the final decision rests with the contractor, this determination was developed in consultation with representatives from Advisory Committee members and/or from various state and local provider organizations. Any Carrier Advisory Committee (CAC) related information, including Start Date and End Date of Comment Period, reflects the last time this LCD passed through the Comment and Notice process. Formal comment is not required for LCDs being adopted as part of the MAC transition. Start Date of Comment Period 01/17/2008 End Date of Comment Period 03/01/2008 Start Date of Notice Period 06/03/2008 Revision History Number R#1 Revision History Explanation R#1: This revised LCD is effective for all National Government Services jurisdictions on July 18, 2008 with these exceptions: for Connecticut Part B the LCD is effective on August 1, 2008; for Upstate New York Part B, the LCD is effective on September 1, 2008; and for New York and Connecticut Part A, the LCD is effective on November 14, For New York Part A (contract 00308), the content of this LCD is currently in effect but the LCD will be transferred to the J-13 contract number on November 14, This LCD was revised during the Notice period of 05/15/ /30/2008 to add the Jurisdiction 13 (J-13) MAC contractor numbers. The CMS Statement of Work for the J13 Medicare Administrative Contract (MAC) requires that the contractor retain the most clinically appropriate LCD within the jurisdiction. This NGS policy is being promulgated to the J13 MAC as the most clinically appropriate LCD within that jurisdiction. The NGS roster of LCDs has been developed under the combined experience of seven Medicare contractor medical directors. The criteria for inclusion in this roster includes areas of identified CERT errors, especially repetitive errors; high volume/high dollar/pervasive problems; patient safety issues; potential for automation; beneficiary access to new technology; implementation of NCD; narrative medical necessity parameters for medical review and provider education; and CMS/law enforcement mandates.

24 Page 24 of 24 NGS LCDs have undergone an advice and comment process from the providers in 23 states. This advice and comment process, the most comprehensive among all Medicare contractors, has ensured that NGS policies have benefited from the most in-depth and scientifically rigorous scrutiny. The NGS policy development process has resulted in the most clinically appropriate LCDs for providers and Medicare beneficiaries. Reason for Change Not applicable Last Reviewed On Date 06/03/2008 Related Documents Article(s) A Nerve Conduction Studies (NCS)/Electromyography (EMG) - Supplemental Instructions Article LCD Attachments NCS - Comment and Response (121,076 bytes) Close

Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies

Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies [Preauthorization Required] Medical Policy: MP-ME-09-09 Original Effective Date: November 5, 2010 Reviewed: November 5, 2010 Reviewed: November

More information

Aetna Nerve Conduction Study Policy

Aetna Nerve Conduction Study Policy Aetna Nerve Conduction Study Policy Policy Aetna considers nerve conduction velocity (NCV) studies medically necessary when both of the following criteria are met: 1. Member has any of the following indications:

More information

Billing and Coding Guidelines: NEURO-005 Nerve Conduction Studies and Electromyography. Contractor Name Wisconsin Physicians Service (WPS)

Billing and Coding Guidelines: NEURO-005 Nerve Conduction Studies and Electromyography. Contractor Name Wisconsin Physicians Service (WPS) Billing and Coding Guidelines: NEURO-005 Nerve Conduction Studies and Electromyography Contractor Name Wisconsin Physicians Service (WPS) Contractor Number 00951, 00952, 00953, 00954 05101, 05201, 05301,

More information

EMG and the Electrodiagnostic Consultation for the Family Physician

EMG and the Electrodiagnostic Consultation for the Family Physician EMG and the Electrodiagnostic Consultation for the Family Physician Stephanie Kopey, D.O., P.T. 9/27/15 The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Marketing Committee

More information

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MedStar Health, Inc. POLICY AND PROCEDURE MANUAL SUBJECT: Nerve Conduction Velocity Studies/Electrodiagnostic INDEX TITLE: Studies/Neuromuscular Medical Management Junction Testing ORIGINAL DATE: March

More information

Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies

Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies [For the list of services and procedures that need preauthorization, please refer to www.mcs.com.pr Go to Comunicados a Proveedores, and

More information

3nd Biennial Contemporary Clinical Neurophysiological Symposium October 12, 2013 Fundamentals of NCS and NMJ Testing

3nd Biennial Contemporary Clinical Neurophysiological Symposium October 12, 2013 Fundamentals of NCS and NMJ Testing 3nd Biennial Contemporary Clinical Neurophysiological Symposium October 12, 2013 Fundamentals of NCS and NMJ Testing Peter D. Donofrio, M.D. Professor of Neurology Vanderbilt University Medical Center

More information

a) Nerve conduction studies (NCS) test the peripheral nervous system for:

a) Nerve conduction studies (NCS) test the peripheral nervous system for: Health Plan Coverage Policy ARBenefits Approval: 11/02/2011 Effective Date: 01/01/2012 Revision Date: 09/18/2013 Comments: Code additions only. Title: Electrodiagnostic Testing Document: ARB0256 Public

More information

Neuromuscular Medicine Fellowship Curriculum

Neuromuscular Medicine Fellowship Curriculum Neuromuscular Medicine Fellowship Curriculum General Review Goals and Objectives Attend weekly EMG sessions as assigned Take a Directed History and Exam of each EMG patient Attend every other week Muscle

More information

Name of Policy: Neuromuscular and Electrodiagnostic Testing (EDX): Nerve Conduction Studies (NCS) and Electromyography (EMG) Studies

Name of Policy: Neuromuscular and Electrodiagnostic Testing (EDX): Nerve Conduction Studies (NCS) and Electromyography (EMG) Studies Name of Policy: Neuromuscular and Electrodiagnostic Testing (EDX): Nerve Conduction Studies (NCS) and Electromyography (EMG) Studies Policy #: 228 Latest Review Date: August 2015 Category: Medicine Policy

More information

Local Coverage Determination (LCD) for Epidural (L29165)

Local Coverage Determination (LCD) for Epidural (L29165) Local Coverage Determination (LCD) for Epidural (L29165) Contractor Information Contractor Name First Coast Service Options, Inc. Back to Top Contractor Number 09102 Contractor Type MAC - Part B LCD Information

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY Original Issue Date (Created): 10/4/2002 Most Recent Review Date (Revised): 1/27/2015 Effective Date: 6/1/2015 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS

More information

ICD-9-CM coding for patients with Spinal Cord Injury*

ICD-9-CM coding for patients with Spinal Cord Injury* ICD-9-CM coding for patients with Spinal Cord Injury* indicates intervening codes have been left out of this list. OTHER DISORDERS OF THE CENTRAL NERVOUS SYSTEM (340-349) 344 Other paralytic syndromes

More information

Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)

Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705) Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705) Contractor Information Contractor Name Novitas Solutions, Inc. LCD Information Document Information LCD

More information

Billing and Coding Guidelines

Billing and Coding Guidelines Billing and Coding Guidelines Contractor Name Wisconsin Physicians Service Insurance Corporation Title INJ- 018 Botulinum Toxin Type A & Type B Revision Effective Date 10/01/2011 AMA CPT/ ADA CDT Copyright

More information

ELECTRODIAGNOSTIC MEDICINE

ELECTRODIAGNOSTIC MEDICINE ELECTRODIAGNOSTIC MEDICINE OBJECTIVES BEGINNER Patient Care Perform a comprehensive electrodiagnostic evaluation of each patient and to provide a concise diagnosis and plan for further treatment Describe

More information

Recommended Policy for Electrodiagnostic Medicine American Association of Neuromuscular & Electrodiagnostic Medicine

Recommended Policy for Electrodiagnostic Medicine American Association of Neuromuscular & Electrodiagnostic Medicine Recommended Policy for Electrodiagnostic Medicine American Association of Neuromuscular & Electrodiagnostic Medicine Executive Summary The electrodiagnostic medicine (EDX) evaluation is an important and

More information

Local Coverage Determination (LCD) for Nervous System Studies - Autonomic Function, Nerve Conduction and Electromyography (L28282)

Local Coverage Determination (LCD) for Nervous System Studies - Autonomic Function, Nerve Conduction and Electromyography (L28282) Search Home Medicare Medicaid CHIP About CMS Regulations & Guidance Research, Statistics, Data & Systems Outreach & Education People with Medicare & Medicaid Questions Careers Newsroom Contact CMS Acronyms

More information

National Medical Policy

National Medical Policy National Medical Policy Subject: Nerve Conduction Studies Policy Number: NMP237 Effective Date*: September 2005 Updated: September 2015 This National Medical Policy is subject to the terms in the IMPORTANT

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: electrodiagnostic_studies 2/2008 10/2015 10/2016 10/2015 Description of Procedure or Service Electrodiagnostic

More information

Entry-level Educational Curriculum Content Guidelines for Electrophysiological Examination and Evaluation

Entry-level Educational Curriculum Content Guidelines for Electrophysiological Examination and Evaluation Entry-level Educational Curriculum Content Guidelines for Electrophysiological Examination and Evaluation Introduction: Section on Clinical Electrophysiology and Wound Management American Physical Therapy

More information

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management Coding and Payment Guide for Anesthesia Services An essential coding, billing, and reimbursement resource for anesthesiology and pain management 2011 Contents Introduction...1 Coding Systems... 1 Claim

More information

Electrodiagnostic Testing

Electrodiagnostic Testing Electrodiagnostic Testing Table of Contents Related Policies Policy Number 359 Policy Statement Purpose.. 1 2 Competency in Electrophysiologic Testing Original Effective Date: Current Approval Date: 1/1997

More information

ELECTROMYOGRAPHY (EMG), NEEDLE, NERVE CONDUCTION STUDIES (NCS) AND QUANTITATIVE SENSORY TESTING (QST)

ELECTROMYOGRAPHY (EMG), NEEDLE, NERVE CONDUCTION STUDIES (NCS) AND QUANTITATIVE SENSORY TESTING (QST) AND QUANTITATIVE SENSORY TESTING (QST) Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical

More information

6. 7. 8. 9. 10. 11. An overview EDX studies 12. 13. and inappropriate 14. 15. 16. 17. publication, EDX. from

6. 7. 8. 9. 10. 11. An overview EDX studies 12. 13. and inappropriate 14. 15. 16. 17. publication, EDX. from Recommendedd Policy for Electrodiagnostic Medicine Executive Summary The electrodiagnostic medicine (EDX) evaluation is an important and useful extensionn of the clinical evaluation of patients with disorders

More information

Recommended Policy for Electrodiagnostic Medicine

Recommended Policy for Electrodiagnostic Medicine Recommended Policy for Electrodiagnostic Medicine Executive Summary The electrodiagnostic medicine (EDX) evaluation is an important and useful extension of the clinical evaluation of patients with disorders

More information

Electromyography and Nerve Conduction Studies

Electromyography and Nerve Conduction Studies Electromyography and Nerve Conduction Studies Policy Number: 2.01.95 Last Review: 10/2015 Origination: 10/2015 Next Review: 10/2016 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide

More information

Basic Nerve Conduction Studies. Holli A. Horak, MD University of Arizona August 2015

Basic Nerve Conduction Studies. Holli A. Horak, MD University of Arizona August 2015 Basic Nerve Conduction Studies Holli A. Horak, MD University of Arizona August 2015 Introduction Review nerve physiology/ anatomy Purpose of testing Study design Motor NCS Sensory NCS Mixed NCS Interpretation

More information

Electrodiagnostic Testing

Electrodiagnostic Testing Electrodiagnostic Testing Electromyogram and Nerve Conduction Study North American Spine Society Public Education Series What Is Electrodiagnostic Testing? The term electrodiagnostic testing covers a

More information

Chiropractic ICD 9 Code List

Chiropractic ICD 9 Code List Use of valid ICD 9 codes, billed with appropriate and corresponding CPT codes, benefits providers by facilitating treatment authorization and claims payment. The use of valid and appropriate codes also

More information

eglobaltech CBR201406 Electrodiagnostic Testing Moderator: Molly Wesley July 09, 2014 3:00 p.m. ET

eglobaltech CBR201406 Electrodiagnostic Testing Moderator: Molly Wesley July 09, 2014 3:00 p.m. ET CBR201406 Electrodiagnostic Testing July 09, 2014 3:00 p.m. ET Contents Miscellaneous Topics... 2 NCS Codes (95905, 95907 95913)... 4 EMG Codes (95860, 95861, 95863 95870)... 4 NCS & EMG Combination Codes

More information

Contractor Number 11302. Oversight Region Region IV

Contractor Number 11302. Oversight Region Region IV Local Coverage Determination (LCD): Spinal Cord Stimulators for Chronic Pain (L32549) Contractor Information Contractor Name Palmetto GBA opens in new window Contractor Number 11302 Contractor Type MAC

More information

Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes

Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes As of October 1, 2015, all health care entities covered by the Health Insurance Portability and Accountability Act (HIPAA) will be required to use

More information

EMG AND NCS: A PRACTICAL APPROACH TO ELECTRODIAGNOSTICS

EMG AND NCS: A PRACTICAL APPROACH TO ELECTRODIAGNOSTICS EMG AND NCS: A PRACTICAL APPROACH TO ELECTRODIAGNOSTICS Dr. Harp Sangha, Dr. Tania R. Bruno Staff Physiatrists Toronto Rehab UHN Lecturers, Department of Medicine University of Toronto February 1, 2013

More information

Electrodiagnostic Assessment: An Introduction to NCS and EMG

Electrodiagnostic Assessment: An Introduction to NCS and EMG Electrodiagnostic Assessment: An Introduction to NCS and EMG Barry Bernacki BSc MD FRCPC CSCN (EMG) Clinical Asst. Professor EMG Lab Director Saskatoon City Hospital Objectives Understand technique and

More information

Intrathecal Baclofen for CNS Spasticity

Intrathecal Baclofen for CNS Spasticity Intrathecal Baclofen for CNS Spasticity Last Review Date: November 13, 2015 Number: MG.MM.ME.31bC5 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or

More information

Intra-operative Nerve Monitoring Coding Guide. March 1, 2011

Intra-operative Nerve Monitoring Coding Guide. March 1, 2011 Intra-operative Nerve Monitoring Coding Guide March 1, 2011 Please direct any questions to: Patty Telgener, RN Vice President, Reimbursement Services Emerson Consultants (303) 526-7604 (office) (303) 570-2159

More information

Role of Electrodiagnostic Tests in Neuromuscular Disease

Role of Electrodiagnostic Tests in Neuromuscular Disease Role of Electrodiagnostic Tests in Neuromuscular Disease Electrodiagnostic tests Electroencephalogram (EEG) Electromyography (NCV, EMG) Cerebral evoked potentials (CEP) Motor evoked potentials (MEP) Electronystagmogram

More information

December 29, 2012. Dear Acting Administrator Tavenner:

December 29, 2012. Dear Acting Administrator Tavenner: December 29, 2012 Marilyn B. Tavenner Acting Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Attention: CMS-1590-FC P.O. Box 8013 Baltimore, MD 21244

More information

UltraEMG Course Schedule ULTRA EMG I: Neuromuscular Emphasis Sunday February 9 Introduction and Fundamentals

UltraEMG Course Schedule ULTRA EMG I: Neuromuscular Emphasis Sunday February 9 Introduction and Fundamentals UltraEMG Course Schedule 2014 Saturday February 8 Travel Date 5:00-6:00 Early Onsite Registration ULTRA EMG I: Neuromuscular Emphasis Sunday February 9 Introduction and Fundamentals 6:15am Registration

More information

ICD-10 Cheat Sheet Frequently Used ICD-10 Codes for Musculoskeletal Conditions *

ICD-10 Cheat Sheet Frequently Used ICD-10 Codes for Musculoskeletal Conditions * ICD-10 Cheat Sheet Frequently Used ICD-10 Codes for Musculoskeletal Conditions * Finding the ICD-10 equivalent for an ICD-9 code can be a challenge. This resource of frequently used codes can help when

More information

Pain Management Top Diagnosis Codes (Crosswalk)

Pain Management Top Diagnosis Codes (Crosswalk) Pain Management Top s (Crosswalk) 274.00 Gout arthropathy, M1000 Idiopathic gout, unspecified site unspecified M10011 Idiopathic gout, right shoulder M10012 Idiopathic gout, left shoulder M10019 Idiopathic

More information

Chiropractic ICD-10 Common Codes List

Chiropractic ICD-10 Common Codes List Chiropractic ICD-10 Common Codes List This is a preliminary list of common ICD-10 codes for chiropractic diagnoses. This is a common code list to be used as a guide for coding and is not intended to represent

More information

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010 Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN

More information

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC.

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC. Electrodiagnostic Testing with Same Day Evaluation Management By: Shane J. Burr, MD; Scott I. Horn, DO; Jenny J. Jackson, MPH, CPC; Joseph P. Purcell, DO Dr. Burr practices general inpatient and outpatient

More information

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN MEDICAL POLICY EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN Policy Number: 2015T0004W Effective Date: December 1, 2015 Table of Contents BENEFIT CONSIDERATIONS COVERAGE RATIONALE APPLICABLE CODES..

More information

LCD L30551 - Vitamin B12 Assays Print

LCD L30551 - Vitamin B12 Assays Print LCD L30551 - Vitamin B12 Assays Print Contractor Information Contractor Name: Highmark Medicare Services, Inc. Contractor Number(s): 12102, 12202, 12302, 12501, 12301, 12201, 12401, 12402, 12101, 12502,

More information

Update: The Care of the Patient with Amyotrophic Lateral Sclerosis

Update: The Care of the Patient with Amyotrophic Lateral Sclerosis Update: The Care of the Patient with Amyotrophic Lateral Sclerosis Case Presentation: Part I A 54-year-old woman presents to the neurology clinic referred by her primary care physician for evaluation of

More information

Injection, Tendon Sheath, Ligament, Ganglion Cyst, Carpal and Tarsal Tunnel Supplemental Instructions Article (A47720) Contractor Information

Injection, Tendon Sheath, Ligament, Ganglion Cyst, Carpal and Tarsal Tunnel Supplemental Instructions Article (A47720) Contractor Information Page 1 of 9 Deborah Rondeau From: Saved by Windows Internet Explorer 7 Sent: Saturday, August 23, 2008 7:42 PM Subject: FUTURE ARTICLE : Injection, Tendon Sheath, Ligament, Ganglion Cyst, Carpal and Tarsal

More information

CLINICAL NEUROPHYSIOLOGY

CLINICAL NEUROPHYSIOLOGY CLINICAL NEUROPHYSIOLOGY Barry S. Oken, MD, Carter D. Wray MD Objectives: 1. Know the role of EMG/NCS in evaluating nerve and muscle function 2. Recognize common EEG findings and their significance 3.

More information

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Local Coverage Determination (LCD): NERVE Blockade for Treatment of Chronic Pain and Neuropathy (L35457) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.

More information

Cooled RF Systems. Cooled RF Systems. Reimbursement Guide

Cooled RF Systems. Cooled RF Systems. Reimbursement Guide Kimberly-Clark* Reimbursement Guide Kimberly-Clark * Pain Management Cooled RF Systems Reimbursement Guide Table of Contents Introduction... 3 Disc Biacuplasty (TransDiscal* System)... 5 SInergy* System...

More information

National Coverage Determination. Vagus Nerve Stimulation (VNS)

National Coverage Determination. Vagus Nerve Stimulation (VNS) National Coverage Determination Vagus Nerve Stimulation (VNS) Number NEURO-004 Contractor Name Wisconsin Physicians Service Insurance Corporation AMA CPT Copyright Statement CPT codes, descriptions and

More information

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN CLINICAL POLICY EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN Policy Number: PAIN 019.16 T2 Effective Date: December 1, 2015 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS..

More information

Referral Form & Instructions Questions? Call 1 888 284 5433 and press 7

Referral Form & Instructions Questions? Call 1 888 284 5433 and press 7 Therapist Name: Phone: Referral Form & Instructions Questions? Call 1 888 284 5433 and press 7 1 2 Indicate all products that might be appropriate for your patient. Please check all products that might

More information

Nerve conduction studies

Nerve conduction studies clinical William Huynh Matthew C Kiernan Nerve conduction studies This article forms part of our Tests and results series for 2011 which aims to provide information about common tests that general practitioners

More information

Comments and Responses Regarding Draft Local Coverage Determination: Outpatient Physical and Occupational Therapy Services

Comments and Responses Regarding Draft Local Coverage Determination: Outpatient Physical and Occupational Therapy Services Comments and Responses Regarding Draft Local Coverage Determination: Outpatient Physical and Occupational Therapy Services As an important part of Medicare Local Coverage Determination (LCD) development,

More information

ICD10 Chiropractic Diagnosis Codes

ICD10 Chiropractic Diagnosis Codes ICD10 Chiropractic Diagnosis Codes Disclaimer: When the ICD-10 code requires a 7th character, the code shown assumes "initial." Disclaimer: This information is based on the General Equivalency Mapping

More information

Electrodiagnostic Testing Electromyogram and Nerve Conduction Study

Electrodiagnostic Testing Electromyogram and Nerve Conduction Study Electrodiagnostic Testing Electromyogram and Nerve Conduction Study North American Spine Society Public Education Series What Is Electrodiagnostic Testing? The term electrodiagnostic testing covers a

More information

Anterior horn cell disorders

Anterior horn cell disorders Anterior horn cell disorders Lower motor neurons The LMNs are located in the brainstem and spinal cord The spinal LMNs are also known as anterior horn cell. Dorsal anterior horn cells innervate distal

More information

Deborah Rondeau. NY Part B

Deborah Rondeau. NY Part B Page 1 of 8 Deborah Rondeau From: Saved by Windows Internet Explorer 7 Sent: Saturday, August 23, 2008 7:22 PM Subject: NGS Article for Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and

More information

Consensus & Practice Policy Guidelines July 7, 2015 - Volume 31

Consensus & Practice Policy Guidelines July 7, 2015 - Volume 31 American Association of Sensory Electrodiagnostic Medicine Consensus & Practice Policy Guidelines July 7, 2015 - Volume 31 GOLD STANDARD - PAIN DIAGNOSIS PAIN FIBER NERVE CONDUCTION STUDY (PF- NCS) NATIONAL

More information

Clinical Policy Title: Electrodiagnostic Studies: Electromyography and Nerve Conduction Studies

Clinical Policy Title: Electrodiagnostic Studies: Electromyography and Nerve Conduction Studies Clinical Policy Title: Electrodiagnostic Studies: Electromyography and Nerve Conduction Studies Clinical Policy Number: 09.01.04 Effective Date: June 1 st, 2014 Initial Review Date: Jan. 15th, 2014 Most

More information

LOW BACK PAIN; MECHANICAL

LOW BACK PAIN; MECHANICAL 1 ORTHO 16 LOW BACK PAIN; MECHANICAL Background This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the purpose of epidemiological surveillance of a condition

More information

Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383)

Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID

More information

QUESTIONABLE BILLING FOR MEDICARE ELECTRODIAGNOSTIC TESTS

QUESTIONABLE BILLING FOR MEDICARE ELECTRODIAGNOSTIC TESTS Department of Health and Human Services OFFICE OF INSPECTOR GENERAL QUESTIONABLE BILLING FOR MEDICARE ELECTRODIAGNOSTIC TESTS Daniel R. Levinson Inspector General April 2014 OEI-04-12-00420 EXECUTIVE SUMMARY:

More information

Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852)

Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Contractor Information Contractor Name CGS Administrators, LLC Article

More information

Local Coverage Determination (LCD): Medicine: Autonomic Function Tests (L34500)

Local Coverage Determination (LCD): Medicine: Autonomic Function Tests (L34500) Local Coverage Determination (LCD): Medicine: Autonomic Function Tests (L34500) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC LCD Information Document Information

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Foot Care Services Page 1 of 5 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Foot Care Services Professional Institutional Original Effective Date: April 6, 2011

More information

Physician Coding and Payment Guide 2015

Physician Coding and Payment Guide 2015 Targeted Drug Delivery Physician Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party sources and is subject

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): HbA1c (L32939) Contract Number 11202

Contractor Information. LCD Information. Local Coverage Determination (LCD): HbA1c (L32939) Contract Number 11202 Local Coverage Determination (LCD): HbA1c (L32939) Contractor Information Contractor Name Palmetto GBA opens in new window Contract Number 11202 Contract Type MAC - Part B LCD Information Document Information

More information

BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required]

BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required] BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required] Medical Policy: MP-RX-01-11 Original Effective Date: March 24, 2011 Reviewed: Revised: This policy applies to products

More information

ICD-10-CM Codes for Neurology

ICD-10-CM Codes for Neurology Diagnostic Services -CM s for Neurology Behavioral/Cognitive Syndromes F04 F09 F90.9 Amnestic Disorder Due To Known Physiological Condition Mental Disorder Due To Known Physiological Condition Attention-Deficit

More information

Local Coverage Determination (LCD) for Trigger Point Injections (L28310)

Local Coverage Determination (LCD) for Trigger Point Injections (L28310) Page 1 of 8 Search Home Medicare Medicaid CHIP About CMS Regulations & Guidance Research, Statistics, Data & Systems Outreach & Education People with Medicare & Medicaid Questions Careers Newsroom Contact

More information

Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist

Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist Coding and Payment Guide for the Physical Therapist An essential coding, billing, and payment resource for the physical therapist 2013 Contents Introduction...1 Coding Systems... 1 Claim Forms... 3 Contents

More information

UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the Neurology Rotation

UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the Neurology Rotation UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the Neurology Rotation Goals of the Program To acquire the knowledge and skills necessary to assess and provide a management plan for

More information

Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services

Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services CMS Manual System Pub 100-03 Medicare National Coverage Determinations Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 55 Date: MAY 5, 2006 Change

More information

Guidelines for Clinical Neurophysiology

Guidelines for Clinical Neurophysiology Guidelines for Clinical Neurophysiology These Guidelines have been drawn up along the lines of those of the Department of Clinical Radiology to help referring clinicians make the best use of Clinical Neurophysiology.

More information

Differentiating Cervical Radiculopathy and Peripheral Neuropathy. Adam P. Smith, MD

Differentiating Cervical Radiculopathy and Peripheral Neuropathy. Adam P. Smith, MD Differentiating Cervical Radiculopathy and Peripheral Neuropathy Adam P. Smith, MD I have no financial, personal, or professional conflicts of interest to report Radiculopathy versus Neuropathy Radiculopathy

More information

ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015

ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015 Presented by: Teri Romano, RN, MBA, CPC, CMDP ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015 Source: http://journal.ahima.org/2015/02/04/us house committee to hold hearing on icd 10 implementation/ 2 2015 Web_Non

More information

MEDICAL POLICY Chiropractic Services & Spinal Manipulation

MEDICAL POLICY Chiropractic Services & Spinal Manipulation POLICY........ PG-0150 EFFECTIVE......01/13/15 LAST REVIEW... 06/14/16 MEDICAL POLICY Chiropractic Services & Spinal Manipulation GUIDELINES This policy does not certify benefits or authorization of benefits,

More information

Medical Report Checklist: Upper Extremities Peripheral Nerve Disorders Impairments (PND)

Medical Report Checklist: Upper Extremities Peripheral Nerve Disorders Impairments (PND) http://www.pdratings.com/ Craig Andrew Lange craig@pdratings.com California Workers Compensation Certified AMA Guides Impairment & Disability Rating Specialists Voice: (415) 861-4040 / Fax: (415) 276-3741

More information

Multifocal Motor Neuropathy. Jonathan Katz, MD Richard Lewis, MD

Multifocal Motor Neuropathy. Jonathan Katz, MD Richard Lewis, MD Multifocal Motor Neuropathy Jonathan Katz, MD Richard Lewis, MD What is Multifocal Motor Neuropathy? Multifocal Motor Neuropathy (MMN) is a rare condition in which multiple motor nerves are attacked by

More information

Possible ICD-10 Diagnosis Codes for Chronic Pain Procedures

Possible ICD-10 Diagnosis Codes for Chronic Pain Procedures Possible ICD-10 Diagnosis Codes for Chronic Pain Procedures This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal,

More information

LCD for Chiropractic Services (L29099)

LCD for Chiropractic Services (L29099) LCD for Chiropractic Services (L29099) Contractor Information Contractor Name First Coast Service Options, Inc. Contractor Number 09102 Contractor Type MAC - Part B LCD ID Number L29099 LCD Information

More information

Electroneuromyographic studies

Electroneuromyographic studies Electroneuromyographic studies in the diagnosis of Pudendal Entrapment Syndrome BY NAGLAA ALI GADALLAH PROFESSOR OF PHYSICAL MEDICINE, RHEUMATOLOGY& REHABILITATION AIN SHAMS UNIVERSITY Pudendal neuralgia

More information

Local Coverage Determination (LCD) for Surgery: Trigger Point Injections (L30066)

Local Coverage Determination (LCD) for Surgery: Trigger Point Injections (L30066) Local Coverage Determination (LCD) for Surgery: Trigger Point Injections (L30066) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC LCD Information Document Information

More information

PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS

PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS DECISION POINT REVIEW: Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and

More information

Colossus Important Diagnoses. Instructions for How to List Diagnoses

Colossus Important Diagnoses. Instructions for How to List Diagnoses 1 Colossus Important Diagnoses Instructions for How to List Diagnoses 1. Only list diagnoses on HCFA-1500 or CMS-1500 billing forms 2. Use as many billing forms/pages as necessary (4 diagnoses per billing

More information

Late Responses. The F Wave & A Wave. AAET Education Committee Leigha Rios R.NCS.T.

Late Responses. The F Wave & A Wave. AAET Education Committee Leigha Rios R.NCS.T. Late Responses The F Wave & A Wave AAET Education Committee Leigha Rios R.NCS.T. In this paper there will be discussion about two late responses, the F wave and the A wave, or axon reflex. We will look

More information

Anthem Central Region Clinical Claims Edit

Anthem Central Region Clinical Claims Edit Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Chemodenervation of Muscles of Different Areas with Chemodenervation

More information

Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes

Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant expansions or

More information

WHEN TO ORDER; HOW TO INTERPRET

WHEN TO ORDER; HOW TO INTERPRET ELECTROMYOGRAPHY AND 1 NERVE CONDUCTION TESTING: WHEN TO ORDER; HOW TO INTERPRET Ronald N. Kent, M.D., Ph.D. 2 ELECTROMYOGRAPHY AND NERVE CONDUCTION TESTING EMG/NCS Testing is a component of a complete

More information

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328)

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID L29328

More information

Radiculopathy vs. Peripheral Neuropathy. What to do with arm pain? Defining Arm Pain. Arm Pain

Radiculopathy vs. Peripheral Neuropathy. What to do with arm pain? Defining Arm Pain. Arm Pain Radiculopathy vs. Peripheral Neuropathy What to do with arm pain? Miriana G. Popadich RN, MSN Clinical Care Coordinator Brachial Plexus Program Department of Neurosurgery University of Michigan Timing

More information

REHABILITATION SERVICES

REHABILITATION SERVICES REHABILITATION SERVICES Table of Contents GENERAL... 2 TERMS AND ABBREVIATIONS... 2 PRIOR AUTHORIZATION REQUIREMENTS FOR MEDICAID REIMBURSEMENT OF INPATIENT REHABILITATION SERVICES (Updated 4/1/11)...

More information

CMS National Coverage Policy

CMS National Coverage Policy LCD ID Number L32748 LCD Title Respiratory Therapy Rehabilitation Contractor s Determination Number L32748 AMA CPT/ADA CDT Copyright Statement CPT only copyright 2002-2011 American Medical Association.

More information

Treatment of Painful Diabetic Neuropathy

Treatment of Painful Diabetic Neuropathy Treatment of Painful Diabetic Neuropathy Case Presentation: Part I A 60-year-old male with a history of diabetes mellitus type 2 is referred to the neurology clinic by his primary care office for pain

More information

Ambulatory Surgery Center Coding and Payment Guide 2015

Ambulatory Surgery Center Coding and Payment Guide 2015 Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party

More information

A Hidden Challenge in WORKERS COMPENSATION

A Hidden Challenge in WORKERS COMPENSATION Published by the Public Risk Management Association www.primacentral.org A Hidden Challenge in WORKERS COMPENSATION APRIL 2015 A Hidden Challenge in WORKERS COMPENSATION By Dr. John Robinton 2 PUBLIC RISK

More information