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Neurology & Pain Management Coding Alert

Reader Questions:

Stick With 1 Unit of 95869

Published on Fri Aug 26, 2005

Question: Our neurologist conducted electro-myography study of the thoracic paraspinal muscles bilaterally at levels T3 and T4. I reported 95869-50 x 2 but Medicare rejected the claim. Is this correct?


New York Subscriber
Answer: You selected the appropriate code, but you reported too many units.

The descriptor for 95869 (Needle electromyography; thoracic paraspinal muscles [excluding T1 or T12]) specifies "muscles" (plural). For this reason, you may report 95869 only once per session, regardless of the number of levels tested.

And the CMS Physician Fee Schedule assigns a bilateral-procedure indicator of "0" to 95869, meaning that modifier 50 (Bilateral procedure) does not apply. You cannot receive additional reimbursement for bilateral testing.

In this case, you should report a single unit of 95869, with no modifiers attached.
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