Wiki 95874

[celcano]

My physician did a procedure where he injected Botox into 3 extremities under EMG guidance. I have an article that says we should bill EMG guidance for each extremity. However, when I tried billing for 3 units, it has hit an edit in my billing software that says 95874 has an MUE of 1. Is this right? Can I only bill for 1 unit? Any advice would be greatly appreciated.
Thank you!

 

[LisaAlonso23]

95874 is an add-on code, so it may not be billed alone. That may be your problem.

 

[celcano]

I am billing 95874 with 64642 x 1 and 64643 x 2.

 

[marvelh]

There is a difference of policy between CPT and Medicare. CPT parenthetical note for 95873& 95874 - "Do not report more than one guidance code for each corresponding chemodenervation code." Which means that you would be able to bill 95874 with 3 units of service in your scenario.

However, Medicare takes a different stance. It has a MUE limit of 1 unit of service as well as the following excerpt from the NCCI manual (bold emphasis added) - "CPT code 95873 describes electrical stimulation for guidance in conjunction with chemodenervation, and CPT code 95874 describes needle electromyography for guidance in conjunction with chemodenervation. During a patient encounter only one of these codes may be reported with a maximum of one (1) unit of service for guidance in conjunction with chemodenervation regardless of the number of muscles chemodenervated."

Some commercial payers follow Medicare's limitations and may not pay for more than 1 unit of service for the guidance.

Take care,
Marvel

 

[gayathriI]

Same scenario, My physician did a procedure where he injected Botox into1 extremities under EMG guidance. Mr question is do i need to add any modifier for this procedures.
64642
95874. Please help me experts!!
TIA.