Neurosurgery Coding Alert

Do you know which NCS code you’ll report with EMG of extremity?

Patients reporting to your practice for an electromyography (EMG) of the extremities with nerve conduction study (NCS) can be unnerving for coders unprepared for the claim.

The study includes two codes, each of which comes from a different code set. Get one (or both) of these codes wrong and the claim could be headed back to your desk unpaid.

But EMG/NCS reporting can be a breeze if you know what to look for and how to arrive at the proper code. Check out this expert EMG/NCS extremity advice before you file another claim for the study.

Use This Guide to Navigate Potential EMG/NCS Patients

The list of ICD-10 codes that are considered medically necessary to perform these tests is quite lengthy, says Carrie Winter, RHIA, health policy manager for American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Some of these indications are more common than others, but the reasons a patient need these tests are numerous, she explains.

Use this: You can consult your individual payer policies for exact lists of ICD-10 codes that are approved for EMG/NCS, but here are some of the conditions that it can be used to diagnose and treat:

• Focal neuropathies, entrapment neuropathies, or compressive lesions/syndromes such as carpal tunnel syndrome (CTS), ulnar neuropathies, or root lesions; for localization
• Traumatic nerve lesions; for diagnosis and prognosis
• Generalized neuropathies, such as diabetic, uremic, metabolic, toxic, hereditary or immune-mediated
• Neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome or botulism
• Symptom-based presentations such as pain in limb, weakness, disturbance of skin sensation or “paresthesia” when appropriate pre-test evaluations are inconclusive and the clinical assessment unequivocally supports the need for the study
• Radiculopathy: Cervical, lumbosacral
• Plexopathy: Idiopathic, traumatic, inflammatory or infiltrative
• Myopathy including polymyositis and dermatomyositis, myotonic disorders, and congenital myopathies

Note: This is not an exhaustive list of all the conditions that EMG/NCS is allowed for, nor is it a guaranteed list of conditions that all payers will cover. When in doubt, always consult your individual payer policy for lists of acceptable ICD-10 codes.

Step 1: Find the EMG Code

The first part of any EMG/NCS extremity study is an electromyography (EMG) of one or more extremities, confirms Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. This could be done to diagnose a variety of conditions.

When you report the EMG, you’ll choose from these codes, depending on encounter specifics:

• 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas)
• 95861 (Needle electromyography; 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)

Step 2: Find the NCS Code

Once you’ve figured out the proper EMG code for your provider’s services, you’re ready to tackle the NCS portion of the claim.

“The EMG determines whether there is a breakdown in the communication between the nerve and the muscles, and the nerve conduction study tests how long it takes the nerve signal to travel to its destination and cause a muscle response,” Bucknam explains.

When your provider performs the NCS after the extremity EMG, you’ll choose from one of the following codes, depending on encounter specifics:

• +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))

Note: As CPT^® indicates in the codes themselves, these are add-on codes — not to be reported by themselves, only as a component of another service. Use of +95885 or +95886 without a primary procedure code will be met with suspicion and denial by payers.

Step 3: Tally Provider Orders

Bucknam reminds coders that they have to look in the provider’s orders to make sure the documentation is complete before submitting an EMG/NCS of the extremities. “One of the most frequent errors we see for billing these tests is that the ordering provider just orders an EMG when both an EMG and NCS are needed,” she says. “Less frequently we see only an NCS ordered when EMG is also needed.”

Many surgeons “interpret these orders to mean ‘perform both tests when needed,’ but that is not acceptable from a billing and reimbursement standpoint. If these codes are audited, the payer will expect to see an order for each test to be performed.

“If only an EMG is ordered, only an EMG can be performed. If the neurologist feels that the patient needs additional studies to appropriately identify the condition, s/he should contact the ordering provider to amend or correct the order,” Bucknam relays.

Nonetheless, there may be circumstances in which only one of the categories of tests is performed. For example, if a physician wants confirmation of carpal tunnel syndrome (CTS), a nerve conduction test alone may be requested to confirm slowing of conduction velocity through the carpal tunnel.