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Noridian EMG Denials

Sep 22, 2016

AAPM&R received notice that members are receiving denials for needle EMGs even when using appropriate ICD-10 codes, referring to a new Noridian LCD released June 2016. Noridian erroneously put an edit in place in June that required a Group II diagnosis code for all needle EMGs, even if they are performed with an NCS. This group is mostly injury codes, and the edit is not appropriate. Group one should be for NCS and needle EMG together; Group 2 for NCS and needle EMG together OR needle EMG alone. We have been advised that members should appeal all incorrect denials that they receive. Appeals should be successful without the need to change the diagnosis code.