Specialty rules are applied to the practice's payers, documentation, and schedule during the engagement.
Where the billing gets difficult
Testing billed without a report
A technician file is not an interpretation. Claims go out before the neurologist signs, then fail review.
Nerve-conduction unit errors
Units follow the study definition and the nerves actually tested. Templates overstate units.
Drug indication mismatches
A payer policy for migraine or spasticity is not a policy for wrinkles. The diagnosis and the dose have to fit the covered use.
Coding considerations
Interpretation codes
Professional interpretation is billed when the signed report exists and the technical component is not double-billed.
EMG and nerve conduction
Codes follow the muscles and nerves documented. Add-on codes are not a flat multiplier.
Injection and drug codes
The drug and the administration are separate. Wastage modifiers are used only when the documentation and the payer rule support them.
Documentation the claim needs
- Signed test interpretation
- Nerves or muscles studied, when those codes are used
- Indication, dose, and site for injectable drugs
- A distinct E/M when a visit is billed with a procedure
Reimbursement complexity
Neurology denials cluster around test units and around drug policies. An authorization for a drug that does not match the dose given is a preventable write-off. EEG and EMG revenue stalls when reports are unsigned. Office E/M is comparatively straightforward and should not be used to hide a test that was the real service. Patient balances rise when a noncovered indication was not discussed before the drug was given.
Proposed approach
01
Hold tests for the report
No interpretation charge is released from a technician note alone.
02
Audit units against the tracing
A sample of nerve-conduction claims is compared with the study log.
03
Match drugs to policy before administration
Auth, diagnosis, and dose are checked against the payer policy the practice has on file.
Workflow checks
- Report-signature queue
- Unit review for electrodiagnostic studies
- Drug authorization match
- Cosmetic versus medical indication flag
Questions
Do you bill hospital EEG technical fees?
Technical components are billed only when the practice performed them. Hospital technical fees are not part of the proposed scope.
Will you choose a diagnosis that matches a drug policy?
No. The diagnosis has to be the one the neurologist assessed. A query can ask for specificity. It cannot supply a covered indication.