You Be the Coder:
Use 95870 for Limited Muscle Studies
Published on Sat Feb 01, 2003
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: What is the best method to report 95870 in three muscles of each arm (bilaterally)? Mississippi Subscriber
Answer: You should report limited muscle studies (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) per limb. Therefore, when testing two extremities, report 95870 and place a "2" in the unit's box of the CMS-1500 or other claim form. When providing the tests in a facility setting or using equipment not belonging to the reporting physician, append modifier -26 (Professional component) to the claim. According to Medicare's Physician Fee Schedule, modifier -50 (Bilateral procedure) is not appropriate to 95870 (column S of the Fee Schedule includes a 0 indicator). When billing for multiple limbs, however, you may choose to attach modifiers -LT (Left side) and -RT (Right side) to specify that the neurologist tested different limbs. Alternatively, append modifier -59 (Distinct procedural service) to the second and subsequent units of 95870 to specify that the physician tested several distinct anatomic locations.