Neurology & Pain Management Coding Alert

Question: Our neurologist performed a paraspinal thoracic electromyogram (EMG). He uses needles up and down the patient's spine and says he tested two arms and T1-T12. How should I code this encounter?

Nevada Subscriber Answer: A complete study of a single extremity (95860, Needle electromyography; one extremity with or without related paraspinal areas) requires evaluation of extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal and femoral, but not sub-branches) or four spinal levels, with a minimum of five muscles studied per limb.

The CPT code description for a single extremity includes the related paraspinal muscles. For an upper extremity EMG exam, that includes the cervical paraspinal muscles along with T1 and T2.

If your neurologist performed and documented the requirements for testing two upper extremity EMGs and the T3-T11 paraspinal muscles, you should report the services with 95861 (... two extremities with or without related paraspinal areas) and 95869 (... thoracic paraspinal muscles [excluding T1 or T12]).

According to Correct Coding Initiative (CCI) edits, 95869 is a component code of 95861 -- which means you wouldn't usually report the codes together because 95861 (as the comprehensive code) includes the service represented by 95869 (as the component code).

Coding exception: If your physician's documentation indicates that he performed the thoracic paraspinal testing in a separate and distinct location (not T1-T2) or during a different session, then the guidelines allow you to bypass the edit with modifier 59 (Distinct procedural service) and report both codes.