Neurology & Pain Management Coding Alert

Most payers allow electromyographic (EMG) guidance with Botox injections to ensure the proper needle location within the treated muscles - and if you're not reporting these services, you're missing deserved reimbursement.
 
Each Medicare carrier and private insurer provides its own list of allowable EMG codes, so you should check with your payer prior to reporting these procedures. The most commonly used include:

95860 - Needle electromyography; one extremity with or without related paraspinal areas
95861 - ... two extremities with or without related paraspinal areas
95863 - ... three extremities with or without related paraspinal areas
95864 - ... four extremities with or without related paraspinal areas
95867 - ... cranial nerve supplied muscle(s), unilateral
95868 - ... cranial nerve supplied muscles, bilateral
95869 - ... thoracic paraspinal muscles (excluding T1 or T12)
95870 - ... limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters. Select EMG Codes by Location You must bill EMG guidance by location. For example, if the neurologist provides an injection to one arm under guidance, report 95860 (in addition to the code for the injection and supplies), says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. But if he or she provides injections under guidance bilaterally, report 95861, she says.
 
And, you may report an E/M service on the same date as a Myobloc injection as long as the physician provides a significant and separately identifiable evaluation and you append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a reimbursement consulting firm recently relocated to Brick, N.J.
 
For instance, the cervical dystonia patient arrives for her Myobloc injection, complaining of pain in her neck at the previous injection site. The neurologist suspects an infection and performs a level-two evaluation of the patient, only to find that the patient has minor bruising on the neck at the prior injection site but no infection. He then administers the Myobloc injection for that visit. You should code the encounter as follows:

64613 (for the Myobloc injection)
333.83 (to describe cervical dystonia)
J0587 x 25 units (for 2,500 units of the drug injected)
99212-25 (for the evaluation of the patient's neck)
920 (Contusion of face, scalp, and neck [except eye(s)]).