Neurology & Pain Management Coding Alert

Question: What are the guidelines for billing the technical component of diagnostic tests, e.g., EMG and NCS, for a hospital inpatient brought to the office for the test? In the past, we have only billed for the professional component, using modifier -26.

Montana Subscriber  
Answer: The technical component of a diagnostic test may be indicated by reporting the appropriate CPT code with HCPCS modifier -TC (technical component). For instance, for an electromyography (EMG) on one limb, use 95860-TC to report the technical component only. This indicates to the payer that the facility owns the diagnostic equipment but did not interpret the tests. However, technical-component charges are institutional charges and are not billed separately by physicians.
 
CPT codes for EMGs (95860-95870) and nerve conduction studies (NCS, 95900-95904) include both the technical and professional component. Place of service determines the need to append modifier -26 (professional component). If the neurologists owns the equipment and also interprets (which is what your question seems to indicate) a test provided in his or her office, report the appropriate code with no modifiers attached, e.g., 95860. If the neurologists interprets a diagnostic test performed for a hospital inpatient on equipment owned by the hospital, report the appropriate code, e.g., 95860, with modifier -26 appended.