New Jersey Legislature Fixes Nerve Conduction Statute

On January 16, one of his last days in office, Governor Jon Corzine signed into law a bill correcting an error that restricted both performance and interpretation of NCSs to physicians and certain other health care professionals. The law took effect immediately. It is now again be statutorily legal for physicians to supervise the performance of NCSs by technologists.

It was never the legislature's intent to prohibit this practice. The inadvertent addition of a single word to a 2005 law during committee revision changed the meaning to require both interpretation and performance of NCSs by physicians and certain other health care professionals. That problem is now fixed.

CPT Publishes Guidance for Consultation Coding

CPT just released an informational memo addressing consultation services and transfer of care. Much of the memo will not apply for Medicare patients since CMS is no longer accepting consultation codes. The memo suggests that Medicare contractor websites are the best place to locate further coding inforamtion for Medicare patients.

Unfortunately, a lack of direction from CMS to contractors has resulted different solutions for reporting low-level inpatient consultations. Until more specific guidance from CMS is given, adhere to the key elements of the service provided when selecting the appropriate code. For example, level 3 inpatient consultation (99253) requires detailed history, detailed exam, and low complexity decision making. This matches exactly with level 1 inpatient hospital care (99221), which requires detailed history, detailed exam, and low complexity decision making.

AMA Morning Rounds: Genzyme expects Pompe drug determination

The AP (1/21) reported, "Genzyme Corp. said Thursday the Food and Drug Administration is scheduled to make a decision on its Pompe disease drug Lumizyme [alglucosidase alfa] by June 17." The agency "had refused to approve Lumizyme until Genzyme fixed manufacturing problems at a facility in Allston Landing, MA," where "some of the bioreactors...contained a virus that slowed down the production of the company's drugs." The drugmaker "is seeking FDA clearance to market the Lumizyme it produces in 4,000-liter bioreactor tanks at its facility in Belgium."

The Boston Business Journal (1/22, Donnelly) reports, "The company said in November it would address the FDA's concerns about the manufacturing processes at the Allston plant by adding internal controls, updating the filling and finishing capabilities and using contract manufacturers and Genzyme's own Ireland manufacturing plant." Since then, "Genzyme has...hired a new senior vice president of global product quality and entered into an agreement with" Hospira Worldwide Inc. "to provide fill and finish manufacturing services." Dow Jones Newswire (1/22, Gryta) also covers the story.

CMS expands Medicare Advantage payment dispute resolution process

Last year, CMS established a payment dispute resolution process for physicians who encountered problems in getting accurate compensation from Medicare Advantage (MA) private fee-for-service (PFFS) plans. Now, CMS has expanded the process to include non-contracted physicians and to include all MA organizations, including HMOs and PPOs, not just PFFS plans. The dispute resolution process can be used by non-contracted physicians to address problems of MA organizations paying less than regular Medicare rates as well as downcoding of claims, but not for denied claims. The contractor handling the disputed payments is First Coast Service Options, Inc. Information on how to initiate the dispute resolution process is available on the FSCO website.

Limited Study EMG: 95870

Parenthetical directions below code 95870 refer users to 95860-95864 when reporting a complete study of an extremity(s). It's not always clear what this means. I have heard from some members who want more information regarding what constitutes a complete study versus a limited study, and when to use the limited code in general.

First, the language of the code 95870 is helpful. "Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters." Study of thoracic paraspinal muscles T2-T11 is reported using 95869. Study of cranial nerve supplied muscle(s) is reported with 95867 (unilateral) or 95868 (bilateral). Study of sphincters is reported with 51785-51792. Additiaonlly, oculoelectromyography is reported with 92262. Finally, laryngeal and diaphragm muscles are also not reported using the limited code becasue they have separate codes, 95865 and 95866 respectively.

Second, five muscles have to be examined to report needle EMG study of a limb. CMS provided specific guidance for codes 95860-95864 in its Final Rule for 1998 on page 59090. “To bill these codes, extremity muscles innervated by three nerves (for example, radial ulnar, median, tibial, peroneal, femoral, not sub branches) or four spinal levels must be evaluated, with a minimum of five muscles studied.” Use this standard for all EMG coding as it is now universally accepted.

If EMG testing fails to meet the five muscle standard described above and cannot be reported using a code for other anatomic sites, report limited needle electromyography code 95870. When appropriate, multiple units of 95870 can be reported for limited study of two, three, or four extremities. It may be necessary to add modifier 59 to additional units of 95870 with some payers.

Needle Electrode Expense

Occasionally I am contacted by a member who wants to know if it is possible bill for the needle electrodes that are used to perform EMG. It is incorrect to report this supply separately becasue it is already included int he value of the procedure code.

Some of these people have tried reporting HCPCS supply code A4215: Needle, sterile, any size, each. I suspect that most of the communication I get on this topic comes after a denial when someone tries A4215 for the first time, because people usually ask if they can bill for the needle, then they ask, "What about A4215?" There may be providers who bill separately for needle electrodes without any problems, but it is technically incorrect and could raise issues in the future during an audit or chart review.

Medicare Consultation Coding: MLN Matters MM6740

Medicare released a Medicare Learning Network bulletin last month that provides additional guidance on billling patient visits instead of consultations. This change regulatory change was discussed in an earlier post when first finalized in November.