EMG and nerve studies: documented or denied.
PM&R and electrodiagnostic claims are a frequent target for medical-necessity edits, frequency limits and documentation requests. Denials usually come from study counts that don't match the report, missing indications, or EMG add-ons billed without the right NCS base code. We reconcile the report to each line and answer documentation requests on time.
Common PM&R claim problems.
Study counts that don't match
Nerve conduction codes are reported by number of studies. If the report and the claim disagree, the payer pays the lower number or denies.
EMG add-ons without the base code
Needle EMG add-on codes (95885–95887) are reported with nerve conduction codes; billed alone or with the wrong combination, they deny.
Documentation requests left unanswered
Electrodiagnostic claims draw records requests. Missing the response window turns a payable claim into a denial.
The lines that decide your reimbursement.
Electrodiagnostic coding is precise: the study count, the indication and the code combination all have to agree.
Read more
| Code / modifier | What it covers | What goes wrong |
|---|---|---|
| 95907–95913 | Nerve conduction studies, by number of studies (1–2 up to 13+) | Claim count doesn't match the report |
| 95885 / 95886 | Needle EMG with NCS, limited / complete extremity (add-on) | Billed without an NCS base code |
| 95887 | Needle EMG, non-extremity, with NCS (add-on) | Muscles tested not documented |
| 95860–95864 | Needle EMG, by number of extremities (without NCS) | Used when NCS was also performed the same day |
| ICD-10-CM | Indication for testing | Symptom codes that don't meet the payer's policy |
| Modifier 26 / TC | Professional / technical component | Split wrongly between physician and facility |
Code descriptions are summarized. Always check the current CPT descriptor, NCCI edits and payer policy.
Strategy backed by experienced specialists.
Strategy & Direct Client Partnership led by Rohit Pandey, backed by a dedicated team of credentialed medical coders (AAPC/AHIMA) and seasoned AR follow-up specialists.
How we work with your team
- We work inside your PM/EHR (eClinicalWorks, NextGen, AdvancedMD and others) under a HIPAA BAA.
- We act as a secondary recovery team on aging AR and complex appeals, alongside your staff.
- Weekly collection reporting to practice leadership.
- 6–7% of net collections; 10% only on No Surprises Act IDR wins.
PM&R billing questions
Why are nerve conduction studies denied?
Common reasons: the number of studies billed doesn't match the report, the diagnosis doesn't meet the payer's policy, frequency limits, or a records request wasn't answered in time.
Can needle EMG add-on codes be billed alone?
No. 95885–95887 are add-on codes reported with nerve conduction study codes. Needle EMG without NCS uses 95860–95864 instead.
Do you handle interventional PM&R procedures too?
Yes, including injections and the imaging and modifier rules that go with them.
10 minutes. One screen. Your numbers.
A short Google Meet with Rohit to look at where your revenue stalls and whether contingency recovery makes sense for your practice. No software change, nothing to pay up front.