Neurology & Pain Management Coding Alert

Questions: Recently, I submitted a claim to Medicare for chemodenervation injection (64614) with needle EMG for guidance (95870). The payer denied the EMG as bundled. Is this correct?


New York Subscriber


Answer: No, your payer's actions were not correct, but the mistake may have been due to a recent change in CMS policy.

In the spring of 2004, the National Correct Coding Initiative included changes that limited the use of electromyographic guidance with chemodenervation procedures 64612-64614 and 64640, with even more restrictive rules set to go into effect on Jan. 1, 2005.

Under a compromise worked out by CMS and the American Association of Neuromuscular and Electro-diagnostic Medicine (AANEM), physicians can continue to report 95870 (Needle electromyography; 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) with chemodenervation procedures, including 64614 (Chemodenervation of muscles[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]), until at least 2006.

Long-range plans include the creation of a new CPT add-on code specifically to describe EMG guidance at the time of injection for chemodenervation.

For now, you should appeal the claim and, if necessary, include the page of NCCI that lists the edits for 64614, noting that 95870 is not included in the edits.