Neurology & Pain Management Coding Alert

Getting reimbursed for electromyograms (EMGs) studies of the limbs, 95860-95870, is often difficult. This is because knowing how to bill for these is more than a simple matter of choosing the code which reflects how many limbs have been tested, says Barbara J. Cobuzzi, MBA, CPC, president of Cash Flow Solutions, a medical billing and coding consulting firm in Lakewood, N.J. Neurology coders need to be aware that carriers require a certain number of muscles to be tested in a given limb, and if that number is not met, the claim will be denied or reduced.

Identifying Proper Number of Muscles for Limb EMGs

To bill these codes, 95860, 95861, 95863 and 95864 (needle electromyography of 1, 2, 3, or 4 limbs with or without related paraspinal areas), the extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal, femoral, not sub-branches) or four spinal levels, a minimum of five muscles must be tested per limb. Documentation should be sent with the claims detailing exactly which muscles were tested so that the carrier will see that the requirement has been met.

For example, if the neurologist only tested two muscles in the right arm, it would not be appropriate to bill a 95860 even though an EMG to a single limb was performed. This is because less than five muscles were tested. If the neurologist tested five or more muscles in that arm, 95860 should be billed, accompanied by documentation.

If five muscles were tested in the left leg and six in the left arm, 95861 should be billed. Because you've met the five muscle requirement in each of the two limbs. However, if the neurologist tested three muscles in the left leg and six in the left arm, 95860, the code for a single extremity, should be billed. Because you have not me the five muscle requirement for each of the two limbs.

Limited EMG Studies of Specific Muscles

Cobuzzi states that coders sometimes make the mistake of billing for the limited study of specific muscles (95869 and 95870) multiple times for each, which is incorrect. HCFA has a policy on this, (see the Federal Register, Oct. 31, 1997, Vol.62, No. 211, page 59090) that clearly states that only one unit of these codes can be billed, despite the number of muscles studied or whether unilateral or bilateral tests are done. HCFA also states that 95869 (needle electromyography; thoracic paraspinal muscles) cannot be billed with 95860, 95861, 95863, or 95864 if only T1 and/or T2 are studied when an upper extremity is also evaluated.

Additionally, 95870 (limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than [...]