Neurology & Pain Management Coding Alert

Pinpointing muscles guarantees success

If choosing from the numerous electromyography (EMG) codes feels like a tough workout, it's time to take a breather. Coding experts say all you really need is to identify the specific muscles the physician tested, and you'll be well on the way to selecting the correct EMG code. Follow these five tips and recoup hard-earned reimbursement for EMGs. 1. Count Limbs for 95860-95864  For needle EMG of the arms and legs, CPT offers four codes, depending on the number of extremities the physician studies:
  95860 - Needle electromyography; one extremity with or without related paraspinal areas
  95861 - ... two extremities ...
  95863 - ... three extremities ...
  95864 - ... four extremities ... For instance, if the surgeon evaluates both the left and right arms at the wrist to test for bilateral carpal tunnel syndrome, you should report 95861. For testing of both legs and one arm, such as during diabetes-related neuropathy evaluations, report 95863.
 
In all cases, however, the neurologist must evaluate extremity muscles innervated by three nerves, such as radial, ulnar, median, tibial, peroneal or femoral (but not sub-branches), or four spinal levels, while studying a minimum of five muscles per limb, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. "Medicare guidelines are very specific about the number of muscles required per limb," he says. "Coders should ensure that the physician has clearly listed the number and names of the muscles tested in the medical record to sustain the claim."
 
A single unit of 95860, 95861, 95863 or 95864 includes all muscles of five or more tested in a particular extremity(ies). In other words, you may report only a single unit of 95860-95864 per session: You cannot bill additional units for more than five muscles per extremity. If the physician studies or documents fewer than five muscles per limb, you must report a limited study (95870) rather than 95860-95864," says Tiffany Schmidt, JD, policy director for the American Association of Electrodiagnostic Medicine (AAEM).
 
Because 95860-95864 include testing of related paraspinal muscles, you should not report paraspinal testing separately unless the neurologist studies those levels from T3 to T11 (inclusive). In this case you may report 95869, according to AAEM recommendations. Likewise, if the physician fails to test related paraspinal muscles, this does not constitute a reduced or discontinued service. Therefore, you should not append any modifiers when reporting such services. 2. Supplied by Cranial Nerve? Choose 95867-95868 When coding for electromyographic testing of one or more muscles supplied by the cranial nerves, report either [...]