Eli's Rehab Report

Published on Sat Oct 11, 2003 PDF

If you're charging an E/M service every time the physiatrist conducts electromyographic (EMG) testing, you may be overbilling.
 
In most cases, you cannot report an E/M service in addition to EMG when your physiatrist treats patients referred by other physicians. In other words, if a patient arrives only for testing at the request of another physician, the physiatrist cannot charge for a separate E/M service beyond that normally included as part of the EMG itself, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
 
Many Medicare carriers' local medical review policies specify that the physician cannot report an E/M service in addition to EMG unless the referring physician clearly requests an E/M service, Hammer says.
 
For example, a patient's primary-care physician (PCP) requests that the physiatrist perform EMG to evaluate a patient's unexplained left-side pain and numbness. The PCP does not ask for the physiatrist's consultation or opinion on the patient's condition; he merely requires the EMG results. The physiatrist will provide testing only and share the results with the PCP, but will not provide or charge for an E/M service in addition to the testing.
 
When a physiatrist sees a new patient or a patient with a new complaint for the first time, and the patient was not specifically referred for testing by another physician, you may charge an E/M service. But you should make sure the physiatrist documents all the requirements of a given level of service.
 
For example, a new patient complaining of wrist pain and numbness sees the physiatrist. The physician performs an E/M service and provides electrodiagnostic testing (including EMG) to evaluate the patient for carpal tunnel syndrome. In this case, you may report an E/M service in addition to the testing if you append modifier    -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M service code.