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Neurology & Pain Management Coding Alert

READER QUESTIONS:

More Than 3 EMGs May Mean Difficulties

Published on Sat Jun 25, 2005

Question: Can I report one unit of 95861, two units of 95900, and three units of 95904 together? Should I use any modifiers?


California Subscriber


Answer: Yes, you can bill 95861 (Needle electromyography; two extremities with or without related paraspinal areas), two units of 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) and three units of 95904 (... sensory) together. You don't need to append any modifiers for this code combination.

Many payers will use one line item for the motor or sensory nerve conduction study tests and use box 24G to indicate the multiple units.

For example, if this is the case, you may report 95900 on one line item with "2" in 24G and then report 95904 on a second line with "3" in 24G.

Keep in mind: Most payers will process up to the range of three units per NCS code but may have "difficulties" processing larger numbers of units.

Certain payers may request that you use modifiers -RT (Right side) and -LT (Left side) to separate out into two line items the number of motor and/or sensory performed on each extremity side. For example, the physician performed a total of four motor and six sensory NCS (performed equally on both upper extremities). In this case, you should report:
 

  • 95900-RT 2 units
     
  • 95900-LT 2 units
     
  • 95904-RT 3 units
     
  • 95904-LT 3 units.

    Clinical and coding expertise for You Be the Coder and Reader Questions provided by 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, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.

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