Neurology & Pain Management Coding Alert

Question: Im having a problem with Medicares refusal to pay for EMGs performed by my doctor at the hospital (using hospital equipment). The doctor acted as technician and dictated the interpretation, just as he would have in the office. I billed as I usually do with the place of service being the facility. Medicare insists that this service is being performed by a physician salaried by the hospital and therefore cannot be billed separately. Is this correct?

Neurology Discussion List Participant

Answer: Yes, this is correct. Because the physician conducts the testing in the hospital, he or she can only collect for the professional component of the service by appending modifier -26 (Professional component) to the appropriate electromyography (EMG) test code (e.g., 95860, Needle electromyography, one extremity with or without related paraspinal areas).

In this case, the physician operates the equipment in addition to providing the interpretation and report which seems to suggest that he or she should be able to collect a portion of the technical component of the test. Unfortunately, neither Medicare nor other insurers will "split" the technical component of the test in this manner: Because the test was performed in the hospital, the facility will receive the full value for the technical component of the test, regardless of who operates the equipment.

The physician may attempt to contract with the hospital to receive payment if he or she acts as the "technologist" during testing. The only alternative is for the physician to provide the testing in the office using his or her own equipment, in which case he or she may collect for the full value of the test by reporting the appropriate CPT code without any modifiers attached.