Neurology & Pain Management Coding Alert

Electromyographic (EMG) testing is a basic component of neurological practice, but even these commonly billed procedures present a host of confusing coding issues. Fortunately, Medicare offers explicit instructions for using EMG codes 95860-95872, which, if followed, should ensure a successful claim every time. 5 Muscles, 3 Nerves,1 Extremity Needle EMG tracks and records the electrical activity of skeletal muscle(s). Using a needle electrode placed in the muscle, the physician measures responses at rest, during mild voluntary contraction, and during maximal contraction. The physician then documents the number and type of muscles tested, as well as all normal and abnormal responses, 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 at the University of Pittsburgh School of Medicine. The first group of codes (95860-95864) describes EMG testing of limbs (arms and legs), as follows:
95860 Needle electromyography; one extremity with or without related paraspinal areas
95861 two extremities
95863 three extremities
95864 four extremities According to CMS guidelines posted in the Oct. 31, 1997, Federal Register (Vol. 62, No. 211, p. 59090), to report 95860-95864 the neurologist must evaluate extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal or femoral but not sub branches) or four spinal levels, with a minimum of five muscles studies per limb. For fewer than five muscles, you should report 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) rather than 95860-95864 (see below). The "related paraspinal areas" mentioned in code descriptors 95860-95864 include all paraspinals except those of the thoracic (T3-T11) region, Busis says. Therefore, you should not report paraspinal-area testing separately with 95860-95864 unless the physician studies those between T3-T11, in which case 95869 (Needle electromyography; thoracic paraspinal muscles [excluding T1 or T12]) is applicable (see below). Note, in addition, that because these codes specify the number of limbs tested, you should not use modifier -50 (Bilateral procedure) with 95860-95864. For example, a patient presents with pain in the right leg (729.5, Pain in limb). The neurologist performs EMG on five muscles of the affected leg. In this case, the appropriate code is 95860. If the physician also conducts an EMG on the symptom-free leg to provide a comparison, she may report 95861 (no modifiers are necessary), as long as she meets the minimum testing requirements (five muscles innervated by three nerves each) for each leg. In a second example, a patient presents with indications of bilateral carpal tunnel syndrome, or CTS (354.0), and the [...]