2025 Coding Guide-6: Suggestions and Samples

6: Suggestions and Samples

Pdf Summary

The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) provides sample billing forms and sample letters to assist physicians with reimbursement, billing, and denials. The billing forms include CPT codes for different procedures, units, and modifiers. The sample letters are for appealing claim denials and addressing specific issues.<br /><br />The AANEM encourages physicians to use the sample billing forms to indicate the correct codes and studies for each patient. These forms help the billing department prepare billing information for insurance companies. The sample letters are provided for the most common phone calls received by the AANEM. While the AANEM cannot address individual problems, they can provide guidelines and support documents for discussions with insurance companies. They are also willing to send letters and documents to insurance companies to advocate for the AANEM's position on issues.<br /><br />The document includes several sample appeal letters for different scenarios, such as denial of EMG claims, denial of evaluation and management codes with EDX codes, denial of multiple units of a specific code, and denial when billing 95885 with complete limb study. There are also sample letters to the Board of Medicine regarding nonphysician performing EMG and poor physician EMG.<br /><br />In addition, there is a letter from the AANEM to insurance companies requesting reconsideration of reimbursement policies for nerve conduction studies (NCS) based on the appropriate use of the Appendix J List of Nerves. The AANEM also addresses the denial of reimbursement for E/M codes with EDX codes on the same day and requests a review of policies. Another letter discusses the denial of billing 95885 with a complete limb study and requests reconsideration. Lastly, there are letters to the Board of Medicine regarding inadequate studies performed by nonphysicians and poor quality of care by physicians.<br /><br />The document concludes with a statement from the AANEM urging insurance companies to review their policies to ensure appropriate reimbursement for electrodiagnostic testing and proper coding based on the CPT rules.

Keywords

AANEM

billing forms

CPT codes

claim denials

insurance reimbursement

appeal letters

nerve conduction studies

ncs

electrodiagnostic testing

EMG claims

policy review

nerve conduction studies

nerve conduction study

ncs