Count the nerves wrong and you lose revenue or invite an audit. Miss the minutes on an infusion and the second hour denies. Skip an authorization on a biologic and a single claim can cost tens of thousands. Neurology carries one of the highest denial rates in medicine because its coding is genuinely hard and its prior authorization burden is relentless. Healthcare Logic specializes in neurology revenue cycle management, so every study, every monitoring day, and every infusion is captured and compliant.
Neurology pairs the most difficult diagnostic coding in outpatient medicine with the heaviest authorization load. Electrodiagnostic studies are counted nerve by nerve and muscle by muscle, EEG codes turn on recording parameters, infusions are billed to the minute, and biologics carry five-figure exposure per claim. The result is an initial denial rate among the highest of any specialty, with most denials tracing to documentation and medical necessity.
Nerve conduction studies are billed on the tiered codes 95907 through 95913 by the number of nerves tested, and needle EMG is billed per muscle. Undercount the studies actually performed and revenue walks out the door; overcount and the practice is flagged for audit, an area the OIG has specifically identified as high risk. Every Medicare contractor maintains an active LCD defining covered indications and utilization limits, and LCD non-compliance is the single leading cause of electrodiagnostic denials.
Routine EEG, ambulatory EEG, and long-term video-EEG and epilepsy monitoring follow separate coding hierarchies based on duration, monitoring type, and interpretation level, and a 30-minute study does not bill like a 60-minute one. CMS updated the EEG code set for 2026 to reflect digital recording and consolidated ambulatory monitoring, and a front office coordinator applying codes informally will systematically under-code studies and under-capture revenue without anyone noticing.
Infusion billing is time-based, and an additional hour cannot be billed without enough documented minutes beyond the first, so a single missed start or stop time downcodes the claim. High-cost biologics for multiple sclerosis and migraine prevention require J-code billing, infusion administration coding, step therapy, and prior authorization, where one missed or incorrect authorization can mean tens of thousands of dollars lost on a single infusion claim.
The October 2025 deletion of G35 as a billable multiple sclerosis diagnosis produced an immediate mass-denial event for any practice still carrying it. Coverage criteria for EEG, EMG, and nerve conduction studies are revised regularly, prior authorization for MRI, PET, long-term EEG, and neuromodulation keeps expanding, and a policy in effect six months ago may no longer apply. Generalist billing cannot track this pace, and the denials compound across every claim cycle.
Healthcare Logic provides a free neurology revenue audit -- identifying electrodiagnostic counting and LCD gaps, EEG under-coding, infusion time and authorization exposure, and ICD-10 specificity risk.
Healthcare Logic delivers the full revenue cycle stack adapted to electrodiagnostic coding, EEG and epilepsy monitoring, infusion and biologic billing, and the prior authorization and LCD compliance that define neurology revenue.
Nerve conduction studies coded on the 95907 to 95913 tiers and needle EMG coded per muscle, with each nerve and muscle counted directly from the study report and reconciled to the applicable LCD -- so claims are neither under-counted nor flagged for over-counting.
Routine, ambulatory, and long-term video-EEG coded on the correct hierarchy using the 2026 code set, with EMU recording and interpretation days reconciled to the monitoring log before discharge billing and sleep architecture documentation verified where required.
Time-based infusion billing with exact start and stop times for every drug, correct J-code and administration coding for multiple sclerosis and migraine biologics, and the drug-acquisition tracking that keeps high-cost infusion claims accurate and defensible.
High-complexity neurology E/M and prolonged service codes billed with the precise time documentation they require -- among the most audited codes in the specialty -- plus separate same-day E/M with infusions captured correctly.
Authorization secured before MRI, PET, long-term EEG, neuromodulation, and biologic infusions, with the symptom duration, prior treatment, and clinical necessity documentation payers demand -- so patients are not treated ahead of an approval that never comes.
Front-end medical necessity and ICD-10 specificity checks, NCCI-compliant pairing on same-day EMG and NCS, current LCD alignment, and aggressive appeals -- the discipline that pulls neurology denial rates down from the specialty's punishing baseline.
Healthcare Logic's neurology workflow covers every step from prior authorization through denial recovery -- keeping electrodiagnostic, EEG, and infusion revenue accurate, compliant, and protected from audit.
Neurology billing is too technical to learn on the job and too heavily authorized to manage casually. Per-nerve counting, EEG hierarchies, time-based infusions, biologic authorizations, and constantly shifting LCDs are a full discipline. Healthcare Logic's team works inside it, turning difficult documentation into clean, defensible claims and pulling denial rates down from the specialty's punishing baseline.
Every nerve and muscle counted from the study and reconciled to the LCD, so claims are neither under-counted nor flagged for over-counting.
Routine, ambulatory, and EMU monitoring coded on the correct 2026 hierarchy and reconciled to the log, ending the silent under-coding generalists miss.
Exact infusion times and airtight authorizations protect five-figure biologic claims from time-based and authorization denials.
Coverage criteria and ICD-10 specificity tracked as they change, so events like the G35 deletion never turn into a mass-denial surprise.
Neurology combines genuinely difficult electrodiagnostic coding with one of the heaviest prior authorization burdens in medicine. Nerve conduction studies are coded by the number of nerves tested and EMG by the number of muscles, EEG codes depend on recording duration and monitoring type, and infusion billing is time-based to the minute. Layer in expensive biologics, frequent LCD updates, and high audit scrutiny, and neurology carries an initial denial rate that regularly runs between 20 and 35 percent, far above most specialties.
Nerve conduction studies use the tiered codes 95907 through 95913 based on the number of nerves tested, and needle EMG is billed per muscle using 95860 through 95872. Undercounting leaves revenue uncollected while overcounting triggers audit flags, so we count each nerve and muscle directly from the study report. We also reconcile every study against the applicable Medicare LCD, which defines covered indications and utilization limits, because LCD non-compliance is the leading cause of electrodiagnostic denials.
Yes. Routine EEG, ambulatory EEG, and long-term video-EEG and epilepsy monitoring unit services follow distinct coding hierarchies based on recording duration, monitoring type, and interpretation level, and CMS updated the EEG code set for 2026 to reflect digital recording and consolidated ambulatory codes. We select the correct code from the technologist log and physician interpretation, reconcile recording and interpretation days for EMU stays, and manage the prior authorization that long-term video-EEG now requires.
Yes. Infusion billing is time-based, and an additional hour cannot be billed without enough documented minutes beyond the first hour, so we track exact start and stop times for every drug. High-cost biologics for multiple sclerosis, migraine prevention, and related conditions require J-code billing, infusion administration coding, step therapy, and prior authorization, where a single missed or incorrect authorization can represent tens of thousands of dollars in one denial. We manage the authorization and drug-acquisition tracking that protect these claims.
We attack the structural causes: documentation that supports medical necessity, correct modifiers on same-day EMG and nerve conduction studies, ICD-10 specificity including the codes affected by the October 2025 deletion of G35 for multiple sclerosis, prior authorization secured before high-cost studies and infusions, and NCCI-compliant pairing. Because more than half of neurology denials trace to documentation and medical-necessity gaps, we build those checks into the front end rather than discovering them in denial letters.
Talk to a Healthcare Logic neurology specialist and get a free analysis of your electrodiagnostic coding, EEG capture, infusion authorization, and denial recovery.
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