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New Workers’ Compensation Neuromuscular Plan-Based Audit

October 15, 2018

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) announced on October 12, 2018 that it will conduct a plan-based audit for neuromuscular testing.

Click here to view details of the plan-based audit.

The study will focus on the 10 providers who had the highest number of referrals for neuromuscular testing during the time period of July 1, 2016 to June 30, 2017.

TDI-DWC indicated that the scope will include:

  • Health care providers who referred injured employees for neuromuscular testing where:
  • the health care provider was listed as the referring doctor as reported through medical bill reporting under 28 TAC Chapter 134, Subchapter I (i.e. Medical EDI data);
  • the neuromuscular testing was billed with Current Procedural Terminology (CPT) codes:
  • muscle testing 95831-95834;
  • range of motion 95851-95852;
  • needle EMG 95860-95864; or
  • nerve conduction tests 95907-95913; and
  • the neuromuscular testing was performed from July 1, 2016, through June 30, 2017.
  • Indications for ordering neuromuscular testing are identified by the criteria established in the ODG for treatment (2016-2017), including Appendix D – documenting exceptions to the Guidelines. ODG generally does not recommend neuromuscular testing.
  • The request for medical records gives health care providers an opportunity to provide supporting documentation on the appropriateness for ordering neuromuscular testing.
  • The procedure for determining the medical necessity and appropriateness of health care services is set forth in Section II of the Medical Quality Review Process.