Neurology & Pain Management Coding Alert

Question: When testing paraspinal muscles corresponding to an extremity, should I report 95860 if the physician studies only three muscles?

Indiana Subscriber

Answer: No, you should not report 95860 (Needle electromyography; one extremity with or without related paraspinal areas). To claim 95860, you must test a minimum of five muscles. Instead, for a limited study (that is, testing of four or fewer muscles), you should report 95870 (... 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).
 
You should report limited muscle studies (95870) per limb. Therefore, when testing two extremities, you should report 95870 and place a "2" in your claim form's units box. If the physician performs the tests in a facility setting or if you use equipment that does not belong to him, you should also append modifier -26 (Professional component) to 95870.
 
According to Medicare's Physician Fee Schedule, modifier -50 (Bilateral procedure) is not appropriate with 95870. When billing for multiple limbs, however, you may attach modifiers -LT (Left side) and -RT (Right side) to specify that the neurologist tested different limbs.
 
Alternatively, you can append modifier -59 (Distinct procedural service) to the second and subsequent units of 95870 to specify that the physician tested several distinct anatomic locations.