Handling Billing Of Electro Diagnostic Testing Denials

EDX Medical Billing Denials

If you thought there was no limit to your EDX medical billing, think again. Many physicians believe that the Centers for Medicare and Medicaid services will reimburse each and every EDX test performed. Look into the 2006 current procedural terminology book, appendix J, here you will find the EDX guidelines. To receive proper medical billing reimbursement, CPT guidelines should be followed.

Over the years, the Centers for Medicare and Medicaid services have noticed an abuse of EDX tests. This abuse has led to the medical billing guidelines found in appendix J, of the 2006 CPT book. For different situations and diagnoses, the guidelines indicate how many EDX tests may be submitted for medical billing reimbursement.

For example, if the patient is experiencing numbness and tingling unilaterally, there is a limit. Only three motor nerve conduction studies are allowed, one needle electromyography, two H-reflex tests, and four sensory NCS tests. If the physician performs more than the recommended EDX , and submits them for medical billing reimbursement, Medicare will not pay for the extras.

When the Centers for Medicare and Medicaid services constructed the EDX guidelines, 90% of the patients fell into the recommended number of tests. Although this is a majority, there is still 10% of the population that would need additional EDX tests. If your patient falls within this 10%, you may still receive medical billing reimbursement for the additional tests. Documentation is needed to substantiate medical necessity. You should include a note explaining why the additional tests were performed and why you deserve extra medical billing reimbursement.

Medicare understands that nothing is cut and dry. Patient care and treatment all depends on the specific individual. If your physicians are using their best judgment with the number of EDX tests necessary, you should have no problem receiving proper medical billing reimbursement for those tests.

View all Articles by: Melissa Clark, CCS-P