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Neurology & Pain Management Coding Alert

READER QUESTIONS:

Use Time and Modifiers Carefully for EMGs

Published on Mon May 25, 2009

Question: My neurologist preformed EMGs in a hospital setting on four different patients. Three of them had Medicare and one had Wisconsin Medical Assistance. I billed them as an EMG and each insurer denied the charge because the insurer doesn't pay for EMGs at that place of service (hospital). How do I get paid for the extra time spent with these patients and for the EMG? Wisconsin Subscriber Answer: You need to report the corresponding CPT code with modifier 26 (Professional component) appended, which indicates you are billing only for the professional component. The insurance should process this portion of the diagnostic study without difficulty as long as the service meets any medical necessity or other payer coverage requirements. Technical portion: As for the technical portion of these diagnostic studies, if your neurologist indeed provides not only the computer and supplies but also performs the tests -- that is, provides all [...]
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