Neurology & Pain Management Coding Alert

When you see an EMG, check for evidence of this additional service.

When a patient walks into your practice suffering from an injury related to compressed nerves or demyelination, she could be a candidate for an electromyography (EMG).

You’ll need some coding savvy to file correct claims for these patients, as you’ll have a quartet of EMG codes to choose from. Further, you need to be on the lookout for add-on coding opportunities in certain clinical scenarios — and these add-on opportunities greatly affect EMG code choice.

Take a look at this expert advice on the ins and outs of EMGs.

ALS, MG Patients Could Need EMGs

If your physician conducts an EMG for a patient, you’ll usually report a code from the following set, confirms Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa.:

• 95860, Needle electromyography; 1 extremity with or without related paraspinal areas
• 95861, … 2 extremities with or without related paraspinal areas 
• 95863, … 3 extremities with or without related paraspinal areas
• 95864, …  4 extremities with or without related paraspinal areas

Common diagnoses: According to Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash., the most common EMG scenario in many neurology practices is testing for carpel tunnel syndrome (CTS). However, “any condition that is the result of nerve compression, or where there is nerve demyelination, might include an EMG,” she explains.

Bucknam reports that the provider might also use EMGs to help diagnose or determine the appropriate treatment for:

• herniated discs,
• amyotrophic lateral sclerosis (ALS),
• myasthenia gravis (MG),
• weakness,
• paralysis, or
• muscle twitching.

Best bet: While this is not a definitive list, you should be on the lookout for a possible EMG if the physician is testing for one of the above conditions.

Check Out This EMG Case Study

To get an idea of how an EMG scenario might play out in the office, consider this case study from Bucknam:

A new patient who is an avid tennis player presents with shooting pain from the right side of his neck down his right arm, with some additional aching in his right elbow and some twitching of the finger in his right hand. This is limiting his activity, and also making it hard for him to sleep. After careful examination, the physician determines the injury is likely related to his frequent tennis-playing, and may be tennis elbow or a shoulder injury. He orders an EMG of the right upper extremity and cervical paraspinal area. The testing neurologist’s interpretation confirms tennis elbow (lateral epicondylitis) of the right arm with no indication of cervical spine involvement. The neurologist discharges the patient and instructs him to coordinate follow-up care with his primary care physician (PCP).

On the claim, Bucknam says you should report 95860 for the EMG, with M77.11 (Lateral epicondylitis, right elbow) appended to 95860 to represent the patient’s tennis elbow.

No modifier 26? In the above scenario, the EMG took place in the neurologist’s office, meaning the practice owned the equipment. If the neurologist performed the test in a hospital setting, you would append modifier 26 (Professional component) to 95860 to show that you are only coding for the neurologist’s services, not the EMG equipment.

NCS Necessitates EMG Add-On Code

There are times when the neurologist will perform a nerve conduction study (NCS) along with an EMG during the same encounter. When this occurs, you’ll choose one of the following codes for the EMG, depending on encounter specifics, Falbo confirms:

• +95885, Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure)
• 95886, … complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to code for primary procedure).

Remember: When you report an NCS along with an EMG, you code for the EMG with +95885 or +95886. The base code will be one of the NCS codes from the 95907 (Nerve conduction studies; 1-2 studies) through 95913 (… 13 or more studies) set.

So, if the notes indicate that the neurologist performed a two-study NCS along with a complete EMG on a patient’s left arm, report 95907 for the NCS and +95886 for the EMG.

Be on the lookout for EMG/NCS claims, as the two services often go together. “The EMG determines whether there is a breakdown in the communication between the nerve and the muscles, and the NCS tests how long it takes the nerve signal to travel to its destination and cause a muscle response,” Bucknam says.