Neurology & Pain Management Coding Alert

Reader Questions:

EMG That Patient Can't Complete

Question: We had a patient today who came in for an EMG of the left arm. The patient was unable to finish the EMG and got only partway through the test. The patient would like to come back to finish the EMG at a later date. How should we bill for this?

Montana Subscriber

Answer: Code 95870 (Needle electromyography; 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) is to be used to report limited EMG tests.

Furthermore, per the February 2004 CPT Assistant, code 95870 was created to include the following three different kinds of limited needle EMG studies:

• Needle EMG study of a limb or limbs that does not meet the criteria that allow use of 95860 (Needle electromyography; one extremity with or without related paraspinal areas), 95861 (... 2 extremities ...), 95863 (... 3 extremities...), or 95864 (... 4 extremities ...). For instance, study of fewer than five muscles per limb is a limited EMG. Report one unit per each extremity studied.

• Needle EMG of muscles of the thorax or abdomen. Report only one unit of the limited EMG study code regardless of whether it is a unilateral or bilateral limited EMG of the thorax or abdomen.

• Needle EMG study of cervical or lumbar paraspinal muscles. Report a maximum of one unit of 95870 regardless of the number of spinal levels tested or whether the muscles tested were unilateral or bilateral. This code should be reported only if the tested paraspinal muscles do not correspond to an extremity that is also being electromyography tested, such as lumbar paraspinal muscles with a lower extremity EMG.

If the complete EMG diagnostic test had been completed, you should report the appropriate complete extremities code using 95860-95864, rather than assigning the limited study code 95870. For example, if the extremity muscles tested were innervated by three nerves or four spinal levels and a minimum of five arm muscles were studied, you would instead use 95860.