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Neurology & Pain Management Coding Alert

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When Is Modifier 59 Right for EMG?

Published on Sun Apr 12, 2009

Question: A patient had the following EMGs:95861 (Needle electromyography; 2 extremities with or without related paraspinal areas), 95903 (3 units), 95904 (2 units), and 95934 (bilateral). I billed this with 59 modifiers on 95903 and 95904, and with a modifier 50 on 95934. Is this right? South Carolina Subscriber Answer: You do not need modifier 59 (Distinct procedural service) on 95903 (Nerve conduction,amplitude and latency/velocity study, each nerve; motor,with F-wave study) and 95904 (... sensory). The only time you would use 59 is if your physician performs 95900 (... motor, without F-wave study) in addition to a nerve conduction study (NCS) with F-wave (95903),assuming the motor NCS without F-wave diagnostic study was performed on a separate and distinct different nerve. With 95934 (H-reflex, amplitude and latency study;record gastrocnemius/soleus muscle), some insurance companies want single line billing with modifier 50 (Bilateral procedure), while other payers may want the bilateral H-reflex studies [...]
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