2012 Coding Update: Needle EMG with NCV
- By admin aapc
- In Industry News
- July 1, 2012
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CPT® 2012 updates reporting for electrodiagnostic testing with the addition of three codes to describe electromyography (EMG) services performed with a nerve conduction study (NCS).
+95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure)
+95886 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, 5 or more muscles studied, innervated by 3 or more nerves or 4 or more spinal levels (List separately in addition to code for primary procedure)
+95887 Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)
An EMG measures the electrical activity of muscles at rest and during contraction. An NCS measures how well, and how fast, the nerves can send electrical signals. Because these studies provide complimentary information, they are often carried out jointly (for instance, to diagnose 354.0 Carpel tunnel syndrome).
Prior to 2012, EMG was reported separately using 95860-95864 (depending on the number of limbs tested) when performed with an NCS. With the introduction of CPT® 2012, when needle EMG is provided during the same session as a NCS, report the NCS as the primary procedure and turn to +95885-+95887 (depending on location and extent) to describe the EMG.
Code Application Is in the Details
To help your physicians performing EMG with a NCS, be aware of documentation requirements you’ll need to assign codes correctly.
- 95885 describes limited testing of four or fewer muscles when nerve conduction studies (95900-95904) are performed on the same day. Report one unit for each extremity tested. The code can also be used for muscles on the thorax or abdomen (unilateral or bilateral). The physician’s report should identify the muscles tested.
- 95886 requires evaluation of extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal, femoral, not sub-branches) or four spinal levels, with a minimum of five muscles studied per limb. One unit includes all muscles tested in a particular extremity, with or without related paraspinal muscles; up to four units of service (one per limb) may be reported per patient for a given examination. The physician’s report should identify the muscles tested.
- 95887 describes EMG testing at the same time as the NCS for non-extremity muscles. Only one unit may be reported per day. The physician’s report should identify the muscles tested.
Add-on codes 95885-95887 must accompany an appropriate NCS primary procedure code (95900-95904). Codes 95885 and 95886 may be reported together up to a combined total of four units per patient when all four extremities are tested. Codes 95885-95887 should not be reported with other EMG procedures 95860-95864 or 95870 Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters; or motor/sensory NCS by preconfigured array, 95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report.
Coding Example: A physician performs three motor nerve conduction velocity (NCV) without F wave tests, two sensory NCV tests, one limb EMG testing six muscles, and a separate limb EMG testing three muscles. Correct CPT® coding is:
Motor NCV w/o F wave – 95900 x 3 units
Sensory NCV – 95904 x 2 units
EMG, complete – 95886 x 1 unit
EMG, limited – 95885 x 1 unit
EMG Alone Calls for Dedicated Codes
Standalone EMG codes (95860-95864) may be reported when only the EMG study is performed. They cannot be used if the EMG study is performed on the same day as the NCS.
For example, a physician performed a two-limb EMG without NCV on the same day. Both limbs included testing six to seven muscles. In this case, you would report a two-limb EMG with 95861 Needle electromyography; 2 extremities with or without related paraspinal areas (no NCS performed).
You may report 95870 Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters for muscles other than the paraspinals associated with the extremities that were tested. Do not report 95870 when the paraspinal muscles corresponding to an extremity were tested and extremity EMG codes 95860-95864 are also being billed.
Watch Out for Billing Requirements and Limitations
Whenever reporting EMG or an NCS, be aware of minimum requirements many payers impose, such as requirements shared by several Medicare contractors:
- The number of limbs or areas tested should be the minimum needed to evaluate the patient’s condition.
- It is expected that the NCV and EMG reports will contain data from the study as well as the interpretation and diagnosis.
- Repeat testing should be infrequent; limitation of testing services will be determined on the basis of individual medical necessity. An excessive number of services may result in a delay in processing, a denial of the claim, or a request for a refund.
- Documentation addressing the need to evaluate the patient must be maintained by the practitioner and made available to Medicare upon request.
- Documentation stating the indications and circumstances requiring individual nerve conduction studies (without EMG) must be maintained by the provider and made available upon request.
Note also that Medicare places frequency limitations on EMG and NCS procedures, and will reimburse only for the following numbers of tests per year per patient:
- 95900 – eight per year
- 95903 – eight per year
- 95904 – 10 per year
- 95905 – one per limb per year, no more than four per year
- 95934 – two per year
- 95936 – two per year
Per Medicare, reimbursement for additional tests (beyond the number allowed above) will require medical record review.
Meera Mohanakrishnan, MSc, CPC, CPC-H, CPC-P, is manager of operations training at OptumInsight/UnitedHealth Group. You can reach her at firstname.lastname@example.org.
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I am having trouble with humana insurance on getting emg and ncs paid – is anyone else having this problem