Radiculopathies Carpal tunnel syndrome Tarsal tunnel syndrome Trauma to nerves Motor/sensory deficits Hot/cold sensation Neuritis

Size: px

Start display at page:

Download "Radiculopathies Carpal tunnel syndrome Tarsal tunnel syndrome Trauma to nerves Motor/sensory deficits Hot/cold sensation Neuritis"

Blaise Harris
5 years ago
Views:

1 Contact: Toll-free: Locals: Forms: NCVs aid in the evaluation of: Herniated Disks Peripheral neuropathies Numbness and tingling Pain in the extremities Atrophy Entrapment neuropathies Thoracic outlet syndrome Radiculopathies Carpal tunnel syndrome Tarsal tunnel syndrome Trauma to nerves Motor/sensory deficits Hot/cold sensation Neuritis SSEPs aid in the evaluation of: Abnormal skin sensation Nerve root compression Spinal cord tumor Spinal trauma or injury Cervicobrachial syndrome Thoracic outlet syndrome Multiple sclerosis Herniated discs Radiculopathy Neuritis Myelopathy Numbness and tingling Burning sensation Diabetes Plexopathy Musculoskeletal and spinal ultrasound aid in the evaluation of: Brachial injury/irritation Facet syndromes/injury Facet-referred pain Focal neuropathy Hyperflexion/ hyperextension injury Ligament strain/ inflammation Thoracic outlet syndrome Lumbosacral pain Malingering Musculoligamentous injuries Fibrous scars Myofascial irritation Myofascial pain Nerve root area inflammation Dermatomyositis Trigger points/ referred pain

THE 1-2-3 OF EDX TESTING Call or fax a reservation for a technician & equipment to arrive on a day that is convenient to your particular practice.

Fax the final schedule with the time each patient has been scheduled for the studies.

2 THE OF EDX TESTING Call or fax a reservation for a technician & equipment to arrive on a day that is convenient to your particular practice. Fax over the simple forms for each patient to be tested. PMD will call and verify benefits and confirm with your designated staff member. Fax the final schedule with the time each patient has been scheduled for the studies. The technician and equipment arrives at the scheduled time and performs the diagnostic procedures as indicated by the doctors office The technician will leave a data and coding sheet with the appropriate staff person for each patient tested during that scheduled day. Three to Five business days later you will receive summary interpretations from our board-certified neurologists and radiologists for the patients tested. Shortly thereafter, the hard data, graphs and a formal report will arrive via USPS to the referring physicians office for those patients. PMD support staff will be available 24/7 for assistance in coding, billing, scheduling and all other aspects of the service. We are here to help.

HOW TO BUILD A TEST DATE Start identifying your patients who need testing based on the following common conditions. Please review the forms and contact us if you have any questions.

3 HOW TO BUILD A TEST DATE Start identifying your patients who need testing based on the following common conditions. Please review the forms and contact us if you have any questions. We will handle all the verifications and update you accordingly. We look forward to establishing a scheduled date in the near future. COMMON CONDITIONS THAT INDICATE NEED FOR DIAGNOSTIC TESTING Peripheral neuropathies Numbness and tingling Pain in the extremities Diabetic and ischemic neuropathies Entrapment neuropathies Thoracic outlet syndrome Neuromuscular disorders Localized back trauma Nerve root compression Radiculopathies Carpal tunnel syndrome Tarsal tunnel syndrome Plexopathy Trauma to nerves Herniated discs Motor/sensory deficits Hot/cold sensation Neuritis COMPLETE THE TWO FORMS FOR EACH PATIENT FAX TO OR CALL Plan a date and schedule your patients. That s all you need to do.

4 Out of network benefits are split billed in professional & technical components. PMD bills professional and the referring doctor bills the technical AMMA-PROACTIVE MEDICAL DIAGNOSTIC FINANCIAL DATA PPO,POS,WC, PIP YOUR BILLING TEST/STUDY PERFORMED AVERAGE REIMBURSEMENT PMD CHARGE NET UNITS OUT OF NETWORK TECHNICAL COMPONENT DOUBLE NCV WITH DOUBLE ULTRASOUND $2, $0.00 $2, OUT OF NETWORK TECHNICAL COMPONENT DOUBLE NCV $1, $0.00 $1, OUT OF NETWORK TECHNICAL COMPONENT UPPER NCV WITH UPPER ULTRASOUND $1, $0.00 $1, OUT OF NETWORK TECHNICAL COMPONENT LOWER NCV WITH LOWERULTRASOUND $1, $0.00 $1, OUT OF NETWORK TECHNICAL COMPONENT UPPER OR LOWER NCV $ $0.00 $ OUT OF NETWORK TECHNICAL COMPONENT UPPER OR LOWER ULTRASOUND $ $0.00 $ $ PER DAY CHARGE NOT INCLUDED HMO,MEDICARE YOUR BILLING TEST/STUDY PERFORMED MEDICARE FEE SCHEDULE PMD CHARGE NET UNITS IN NETWORK GLOBAL DOUBLE NCV WITH DOUBLE ULTRASOUND $1, $ $1, IN NETWORK GLOBAL DOUBLE NCV $1, $ $ IN NETWORK GLOBAL UPPER NCV WITH UPPER ULTRASOUND $ $ $ IN NETWORK GLOBAL LOWER NCV WITH LOWERULTRASOUND $ $ $ IN NETWORK GLOBAL UPPER OR LOWER NCV $ $ $ IN NETWORK GLOBAL UPPER OR LOWER ULTRASOUND $ $ $ UNITS REPRESENT A SCHEDULED DAY OF TESTING. GENERALLY YOU WANT TO SCHEDULE 5 OR MORE UNITS PER TESTING DAY Medicare and HMO are billed globally by the referring doctor. PMD charges a flat fee far less than the average reimbursement or Medicare fee schedule

5 PMD/AMMA CHARGE SHEET - OUT OF NETWORK/TECHNICAL BILLING (To be filled out by technician for each patient) Date: Referring Physician: Patient: Patient SS#: Patient DOB / / Patient Height Patient Weight NCV UPPER PROFILE: PERFORMED RTTC NCV motor with F-Wave 2 Units X LTTC NCV motor with F-Wave 2 Units X RTTC NCV Sensory 4 Units X LTTC NCV Sensory 4 Units X RTTC SSEP upper extremity 1 Units X LTTC SSEP upper extremity 1 Units X NCV LOWER PROFILE: RTTC NCV motor with F- Wave 3 Units LTTC NCV motor with F- Wave 3 Units RTTC NCV Sensory 3 Units LTTC NCV Sensory The technician 3 provides Units this form for each patient RTTC SSEP lower extremity tested. It contains 1 Units the proper billing codes and LTTC SSEP lower extremity units performed 1 Units for that particular study. This is RTTC H Reflex the superbill for 1 Units your billing person or service LTTC H Reflex 1 Units ULTRASOUND (UPPER): TC Cervical Diagnostic U.S. 1 Unit X TC Thoracic Diagnostic U.S. (T1-T6) 1 Unit X LTTC Left Trapezius U.S (Extremity) 1 Unit X RTTC Right Trapezius U.S. (Extremity) 1 Unit X LTTC Left Extremity U.S. 1 Unit RTTC Right Extremity U.S. 1 Unit ULTRASOUND (LOWER): TC Thoracic Diagnostic U.S. (T6-T12) 1 Unit TC Lumbar/Pelvic Diagnostic U.S. 1 Unit LTTC Left S.I. Joint U.S. (Extremity) 1 Unit RTTC Right S.I. Joint U.S. (Extremity) 1 Unit LTTC Left Extremity U.S. 1 Unit RTTC Right Extremity U.S. 1 Unit OTHER TESTS: TC Brainstem Auditory Evoked Response 1 Unit TC EMG Two Extremities 1 Unit TC EMG Three Extremities 1 Unit TC EMG Four Extremities 1 Unit Technician

6 PMD/AMMA CHARGE SHEET (To be filled out by technician for each patient) HMO / MEDICARE / MEDICAID Date: Referring Physician: Patient: Patient SS#: Patient DOB / / Patient Height Patient Weight NCV UPPER PROFILE: PERFORMED RT NCV motor with F-Wave 2 Units LT NCV motor with F-Wave 2 Units RT NCV Sensory 4 Units LT NCV Sensory 4 Units SSEP upper extremity 1 Units NCV LOWER PROFILE: RT NCV motor with F- Wave 3 Units X LT NCV motor with F- Wave 3 Units X RT NCV Sensory 3 Units X LT NCV Sensory 3 Units X SSEP lower extremity 1 Units X H Reflex 1 Units X ULTRASOUND (UPPER): Cervical Diagnostic U.S. 1 Unit Thoracic Diagnostic U.S. (T1-T6) 1 Unit LT Left Trapezius U.S (Extremity) 1 Unit RT Right Trapezius U.S. (Extremity) This form is 1 provided Unit by the technician for each LT Left Extremity U.S. patient tested. 1 Unit It contains the proper billing codes RT Right Extremity U.S. and units performed 1 Unit for that particular study. This is the superbill for your billing person or service. ULTRASOUND (LOWER): Thoracic Diagnostic U.S. (T6-T12) 1 Unit X Lumbar/Pelvic Diagnostic U.S. 1 Unit X LT Left S.I. Joint U.S. (Extremity) 1 Unit X RT Right S.I. Joint U.S. (Extremity) 1 Unit X LT Left Extremity U.S. 1 Unit RT Right Extremity U.S. 1 Unit OTHER TESTS: Brainstem Auditory Evoked Response 1 Unit EMG Two Extremities 1 Unit EMG Three Extremities 1 Unit EMG Four Extremities 1 Unit Technician

7 ICD-9-CM Codes that Support Medical Necessity for EDX Testing Be advised that these files contain material that is copyrighted by the American Medical Association Malignant neoplasm of cranial nerves Malignant neoplasm of spinal cord Malignant neoplasm of spinal meninges Benign neoplasm of cranial nerves Benign neoplasm of spinal cord Diabetes with neurological manifestations; type II (non insulin dependent type) (NIDDM type) (adult-onset type) or unspec. type, not stated as uncontrolled ; type I (insulin dependent type) (IDDM type) (juvenile type) not stated as uncontrolled ; type II (non-insulin dependent type) (NIDDM type) (adult-onset type) or unspec. type, uncontrolled ; type I (insulin dependent type) (IDDM type) juvenile type), uncontrolled Other and unspec. manifestations of thiamine deficiency Deficiency of other vitamins (vitamin E, vitamin P) Lipoprotein deficiencies Idopathic torsion dystonia Symptomatic torsion dystonia Fragments of torsion dystonia Hereditary spastic paraplegia Werdnig-Hoffmann disease Spinal muscular atrophy, unspec Kugelberg-Welander disease Other spinal muscular atrophy Motor neuron disease Other anterior horn cell diseases Anterior horn cell disease, unspec Other diseases of spinal cord Idiopathic peripheral autonomic neuropathy Peripheral autonomic neuropathy in disorders classified elsewhere Reflex sympathetic dystrophy Autonomic dysreflexia Unspecified disorder of autonomic nervous system 340 Multiple sclerosis Other demyelinating disease of central nervous system Hemiplegia and hemiparesis Infantile cerebral palsy Quadriplegia and quadriparesis Paraplegia Diplegia of upper limbs Monplegia of lower limb Monoplegia of upper limb Unspecified monoplegia Cauda equina syndrome, without mention of neurogenic bladder Cauda equina syndrome, with neurogenic bladder Other specified paralytic syndrome Paralysis, unspec Atypical face pain Bell's palsy Other facial nerve disorder Facial nerve disorder, unspec 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, nec Lumbosacral root lesions, nec Neuralgic amyotrophy

8 Continued Other nerve root and plexus disorders Unspecified nerve root and plexus disorder Mononeuritis of upper limb and mononeuritis multiplex Mononeuritis of lower limb and unspec. Site Hereditary and idiopathic peripheral neuropathy Inflammatory and toxic neuropathy; acute infective polyneuritis ; polyneuropathy in collagen vascular disease ; polyneuropathy in diabetes ; polyneuropathy in malignant disease ; polyneuropathy in other diseases classified elsewhere ; alcoholic poluneuropathy ; polyneuropathy due to drugs ; polyneuropathy due to other toxic agents Chronic inflammatory demyelinating polyneuritis Critical illness polyneuropathy Acute motor neropathy Other inflammatory and toxic neuropathy Myasthenia gravis Myasthenia syndromes in diseases classified elsewhere Toxic myoneural disorders Other specified myoneural disorders Myoneural disorders, unspecified Muscular dystrophies and other myopathies; congenital heredity muscular dystrophy ; hereditary progressive muscular dystrophy ; myotonic disorders ; familial periodic paralysis ; toxic myopathy ; myopathy in endrocrine disease classified elsewhere ; symptomatic inflammatory myopathy in diseases classified elsewhere Critical illness myopathy Acute nectrotizing myopathy Acute quadriplegic myopathy Intensive care (ICU) myopathy Myopathy of critical illness Other myopathies Myopathy, unspecified Myopathy of extraocular muscles Strabismus and other disorders of binocular eye movement 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, thoracic, or lumbar intervertebral disc without myelopathy Displacement of intervertebral disc, site unspec. 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 unspec Intervertebral disc disorder with myelopathy Postlaminectomy syndrome Other specific disc disorder Spinal stenosis in cervical region Brachial neuritis or radiculitis NOS Torticollis, unspec Spinal stenosis, other than cervical

9 Continued Pain in thoracic spine Lumbago Sciatica Thoracic of lumbosacral neuritis or radiculitis, unspec Backache, unspec Infective myositis Spasm of muscle Muscle weakness Neuralgia, neuritis and radiculitis, unspec 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 Transient paralysis of limb Tetany Disturbance of skin sensation Other disturbance, including spasmodic dysphonia Retention of urine, unspecified Incomplete bladder emptying Other specified retention of urine Urge incontinence Urinary frequency Spinal cord injury without evidence of spinal bone injury, cervical Spinal cord injury without evidence of spinal bone injury, dorsal (thoracic) Lumbar spinal cord injury without evidence of spinal bone injury Sacral spinal cord injury without evidence of spinal bone injury Cauda equina spinal cord injury without evidence of spinal bone injury Multiple sites of spinal cord injury without evidence of spinal bone injury Unspecified site of spinal cord injury without evidence of spinal bone injury Injury to nerve roots and spinal plexus Injury to other nerve(s) of trunk, excluding shoulder and pelvic girdles Injury to peripheral nerve(s) of shoulder girdle and upper limb Injury to peripheral nerve(s) of pelvic girdle and lower limb Injury to other and unspecified nerves

10 Average Reimbursements from the top fifty Major Medical, Worker Compensation and MVA Insurers 8 units % % 4 units % UPPER NCV $ units units % 6 units % % 6 units % LOWER NCV $ units units % % % % UPPER US $

Lumbosacral plexus lesion Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy Neuralgic amyotrophy G

Lumbosacral plexus lesion Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy Neuralgic amyotrophy G ICD-9-CM and ICD-10-CM NEUROMUSCULAR DIAGNOSIS CODES Focal Neuropathy ICD-9-CM ICD-10-CM Mononeuropathy G56.00 Carpal tunnel syndrome 354.00 Other median nerve lesion 354.10 Lesion of ulnar nerve 354.20