Eli's Rehab Report
Change the Way You Code Chemodenervation and EMG
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Use 95870 only with 64612-64614, 64640 You should no longer report chemodenervation injection codes (64612-64614, 64640) with a needle electromyography code - unless you use 95870 (limited EMG), according to CMS.
Physiatrists do not perform all the requirements of a full-fledged extremity EMG when performing chemodenervation. Primarily, they use the EMG muscle stimulation to specifically locate the muscles for increased accuracy in injecting botulinum, rather than as a diagnostic tool. The work performed by physiatrists using EMG is not the same as the work for a complete extremity EMG.
Keep in mind: Physiatrists will likely see a decrease in reimbursement because they will no longer be able to report for one limb or two limbs (which have higher RVUs), says Tiffany Schmidt, JD, policy director of the American Association of Electrodiagnostic Medicine (AAEM).
CMS held a conference call with the AAEM and other associations to discuss the issue of using chemodenervation codes with needle EMG codes.
Rather than ruling that you cannot report any needle EMG codes with the chemodenervation codes, CMS allows you to report a limited EMG study, but the time period for doing so is restricted. "Physicians need to create a different needle EMG CPT code as a new add-on code, because CMS has already stated that after one year chemodenervation codes and EMG codes will not be able to be used together," Schmidt says.
The reason: The AAEM advised CMS to go through the American Medical Association CPT process and that enacting a new code takes at least one year. Therefore, CMS is giving the association a year to work on the issues of billing these studies together.
So during the next year, please be aware of this billing change and code appropriately - that is, only use CPT 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 codes 64612-64614 (Chemodenervation of muscle[s] ...), 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). If you have any questions, contact the AAEM Executive Office (507) 288-0100 and ask for the Policy Department.
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