Wiki Billing Consult or New Pt Visit with EMG Test?

[abazcoder]

Hi Everyone,
I would just like to get the general consensus from anyone working with Doctor's who perform EMG/Nerve Conduction tests.

Do you normally bill out a New Patient visit (99202/99203) or a Consultation Code (99242/99243)
along with the EMG/Nerve Conduction CPT codes?

I get conflicting information online as to whether this is allowed or not.
But according to CMS LCD guideline I found it stated,
"Usually an E&M service is included in the exam performed just prior to and during nerve conduction studies and / or electromyography.
If the E&M service is a separate and identifiable service, the medical record must document medical necessity and the CPT code must be billed with a Modifier 25"

Do most of you include an E& M code with a 25 mod and then include your EMG/Nerve Conduction codes with it? Does the Doctor perform an actual exam before he begins the test? Wouldn't that be required if you were going to bill it out this way?
Plus, adding a 25 mod means there's a separate identifiable issue unrelated to the services (the EMG test) and I can't imagine the Doctor would be addressing that when the patient's primary reason for being there is just to get the test done.

Any advice you could give would be greatly appreciated

Thank you!

 

[fsaperstein]

We have this issue, too. I have a doc who wants to do an initial consultation and an emg with nerve conduction, but will we be paid for all 3?

 

[SharonCollachi]

We don't bill a separate E&M service with the EMG/NCV. We do the tests on our own patients (we're pain management as well as physical medicine/rehab), and we have specialists refer their patients to us just for EMG/NCV. The referral contains the detailed report with the other specialists findings (a hand/arm specialist, for example, that suspects cubital tunnel or carpal tunnel, and wants the testing before proceeding with treatment). Our doctor takes some history on the patient, does a brief physical exam (range of motion, sharp/dull discrimination, reflexes, etc.) then does the testing. He is not doing an exam to make a decision on whether testing is appropriate or not; he is doing an exam to get more information to make a more accurate diagnosis.

If a doctor wanted to bill out an exam, I would tell them that we need the patient to come back another day for the testing, after the exam is performed to decide if the testing will be done at all.