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Click a tab to view the frequently asked questions in that category. Click the [+] sign next to any question to view the answer to that question.
- Can a provider have copies of the OCM approved CPT coding worksheets?
Click on any of the below to review the OCM CPT Coding worksheets:
Please note that the CPT codes are based upon the current year and not the individual states' workers' compensation CPT codes. Download the CPT Coding by Year by State.
- If the patient has had prior surgery and the authorization is for MRI, can the radiologist determine that contrast needs to be given?
- Can a provider appeal a denied CPT code on a radiology claim?
- Who reviews medical claim appeals?
Clinical Services staff reviews the medical claim appeals. If an appeal is approved, the Manager of Clinical Services approves the appeal. If Clinical Services recommends denial or partial denial, then a medical consultant, a board certified radiologist must determine the outcome of the appeal.
- How will a provider be notified of the results of a Radiology claim appeal?
- Can a provider appeal a denied Radiology claim appeal?
Yes. A provider who submits medical justification or additional information can complete a second level appeal. A member of OCM's medical advisory board reviews all second level appeals. Second level appeals end the appeal process. For more information, please see the Medical Claim Appeal Policy for Radiology Providers.
- What are the requirements for sample EMG & NCS reports for credentialing?
Three (3) studies are required, including ABNORMAL diagnoses of CTS, Radiculopathy and a Lower Limb study. Samples must include both needle EMG and nerve conduction studies. Numerical data for NCS, including amplitudes, latencies and/or conduction velocities are required. A list of muscles studied is required and the studies cannot be limited studies (less than 5 muscles per limb). (see Guide for Sample Medical Reports policy).
- What is the source for Standards for One Call Medical EMG & NCS Reports?
Sources include:
- American Association of Neuromuscular and Electrodiagnostic (AANEM)
Recommended Guidelines;
- AMA CPT Assistant, Vol. 12, April, 2002 and Vol. 14, July, 2004; Jablecki CK, Busis NA, Brandstater MA, Krivickas LS, Miller RG, Robinton JE. Reporting the Results of Needle EMG and Nerve Conduction Studies: an Educational Report. Prepared by American Association of Neuromuscular & Electrodiagnostic Medicine for Muscle Nerve 2005;32:682-685;
- AANEM Practice Parameters.
- Who can provide additional information on sample medical reports?
Clinical Services will be happy to provide additional information on sample medical reports. You can email or call the Clinical Services Message Center (CSMC) at 800-872-2875, extension 3431. You may also send a request via fax at 973-257-1363.
- How can I contact the Medical Director?
Choose the method of contact that is most convenient for you:
- Email: john_robinton@onecallmedical.com
- Phone: 800-872-2875, extension 3623
- Fax: 973-257-1363
- Mail: John E. Robinton, M.D.
Clincal Services
One Call Medical, Inc.
20 Waterview Blvd.
Parsippany, NJ 07054-0614
- Can a provider receive reimbursement for EMG & NCS testing of an unauthorized limb?
- How can a provider increase referrals?
Referral volume is dependent upon many factors. Provider can control one factor by adherence to the Standards for EMG Reports. For more information, email or call the Clinical Services Message Center (CSMC) at 800-872-2875, extension 3431.
- What are the guidelines for reimbursement of Nerve Conduction Studies?
- What are the guidelines for reimbursement of needle EMG?
- How many muscles are required for a needle EMG of an extremity for CPT code 95860?
- Why does Clinical Services send faxes for Incomplete Bills?
Clinical Services' staff reviews EVERY EMG & NCS medical report upon receipt of a bill and determines if the report received is incomplete. Examples of missing information include:
- list of muscles tested
- numerical data for Nerve Conduction Studies (NCS)
- Amplitudes when only latencies have been submitted for NCS
- Consultation/office notes when Evaluation & Management CPT codes are billed
- Narrative report does not match numerical data/EMG muscles
- Report does not match authorized procedure
- Report does not match billed CPT codes
- Why does Clinical Services send faxes entitled Bill Query?
Bill Query faxes are a service provided to reimburse OCM providers correctly the first time. This also decreases the number of appeals to be processed by both providers and by Clinical Services. Clinical Services' staff reviews EVERY medical report upon receipt of a bill and determines if the bill received is incomplete. Examples of missing CPT codes include:
- No EMG billed but list of muscles documented
- Nerve Conduction Studies (NCS) documented but not billed
- Documentation of many NCS but only one unit billed for motor and/or one unit billed for sensory
- Narrative report does not match billed CPT codes
- When does a provider need to respond to a Bill Query?
- Can a provider appeal a denied CPT code on a Neurodiagnostic claim?
- Who reviews medical claim appeals?
Clinical Services staff members review the medical claim appeals. If an appeal is approved, the Manager of Clinical Services approves the appeal. If an appeal is denied or partially denied by Clinical Services staff, then a medical consultant, board-certified, practicing physician electromyographer completes the appeals.
- How will a provider be notified of the results of an appeal?
- Can a provider appeal a denied Neurodiagnostic appeal?
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