Wiki 95869 billing same day as 95886

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chrisden_7

chrisden_7

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Physician wants to bill for an EMG for thoracic muscles that wasn't done with NCS, but on same visit for the upper right extremity NCS is done with an EMG, from what I can see we cannot charge both 95886 and 95869 on the same day, is this correct or does anyone have any documentation giving further instruction, any advice is appreciated.
 
chrisden_7 said:
Physician wants to bill for an EMG for thoracic muscles that wasn't done with NCS, but on same visit for the upper right extremity NCS is done with an EMG, from what I can see we cannot charge both 95886 and 95869 on the same day, is this correct or does anyone have any documentation giving further instruction, any advice is appreciated.
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There are no NCCI Edits that would instruct not to bill these 2 codes together. The thoracic levels don't innervate the upper extremities (other than T1, which isn't included in 95869), so they really don't have anything to do with each other. I can't see any reason you would be wary of billing them together. What are you looking at that shows they can't be used together?
 
And of course, I hit "reply" before I finished reading everything I should have!

So after reading the instructions under the "Electromyography" section of the CPT, there is a notation that 95869 should not be used on the same day that NCV is performed; 95887 for the thoracic muscles should be used for EMG performed in conjunction with NCV. So it really comes down to, was the thoracic EMG performed in the same session as the upper extremity NCV? If not, and the documentation supports it, my opinion is that 95869 is fine. But if they were done in the same session, 95887 would be the appropriate code.

Final answer! :D
 
Thanks for your answer Megan, yes I looked this up on EncoderPro and it gave me the edit, and yes both procedures were done in the same session and dictation does not support charging both 95869 and 95886, I think I just wanted another person to see it as well before I broke the news to my physician, I have told him previously that we cannot bill both on same day but I'm sure there are going to be times when it just can't be avoided. Again thanks for your input it is much appreciated:)
 
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