New emg codes

[kwieszek]

has anyone else seen the new EMG code - 95886? What exactly does it mean, 5 or more muscles studied, innervated by 3 or more nerves or 4 or more spinal levels?

[adbuck]

Two of the new codes, 95885 and 95886, will now be used instead of codes 95860-95864, 95870, when an EMG is done WITH nerve conduction testing (it usually is). Previously, you reported 95860-95864 depending on the number of COMPLETE (5 or more muscles) limbs you did an EMG on, i.e.:

1 limb - 95860
2 limbs - 95861
3 limbs - 95863
4 limbs - 95864

And 95870 was reported for each LIMITED (less than 5 muscles tested) EMG.

Effective January 1st, however, 95885 will be reported for EACH limb a limited EMG is performed on, and 95886 will be reported for EACH limb a complete EMG is performed on. Example:

Complete bilateral upper EMG: 95886 x 2
Complete EMG of the upper left extremity, and limited EMG of upper right extremity: 95885, 95886
Complete EMG of all four extremities: 95886 x4

It's important to note that these codes also include the related paraspinal areas, when performed. 95887 is for EMGs performed on non-extremity muscle(s) when a nerve conduction test is also done.

These are add on codes, so they cannot be reported on their own. If an EMG ONLY is done, the old codes are used.

[JOgielo]

The physician I work with is confused about the new codes.
They want to know, if they test four muscles in one limb and three spinal muscles in the same limb, would this be considered a complete EMG or a limited EMG?

[mhstrauss]

Originally Posted by JOgielo

The physician I work with is confused about the new codes.
They want to know, if they test four muscles in one limb and three spinal muscles in the same limb, would this be considered a complete EMG or a limited EMG?

I just had a meeting with my docs and this same question came up. My interpretation of the limited test 95885 is that they should not count paraspinal musles towards the total for the code, since the code description states "with related paraspinal areas, when performed", which to me means that it is included in the basic code. So in your example 4 muscles in 1 limb plus 3 related paraspinals = limited EMG 95885.

Hope this helps, and hopefully others will post with their opinions also!!

[JOgielo]

Thank you so much for your help. This definitely answers my question.

[lizzardb]

Thank you for this clear explanation! I had my concerns about explaining this to my coworkers.

[deborahcook4040]

Medicare states that "Procedure modifier was invalid on the date of service" for CPT code 95886 billed with a modifier 26 (done in a facility outpatient setting), with 2 units. NCS codes were billed as primary procedures. Any idea why these might be denying? I've received several denials for these. Maybe I shouldn't use the 26 modifier because it's an add-on code? But we still down't own the equipment, so isn't a 26 modifier required?