Wiki EMG coding PLEASE HELP!!!!

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KristinM522

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Our office if having an issue billing for EMG's as of 2012.

If we bill CPT code 95860 or 95870 with CPT codes from the 95900-95904 category insurances (BCBS, MCR etc) are denying to pay the 95860/70 WITH the 95900-04 charges. Has anybody else had this issue? Are you using a different coding procedure for these studies? Should we be adding a different modifier for the 95900-04 codes?

The CPT book direct us to 95885-95887 for EMG services preformed on the same day as the 95900-04 codes BUT theres debate in the office as to wheather its appropriate or not for us to use them when not testing the related paraspinal areas. Or if the 95885-95887 codes are really interchangable with the 95860/70. Neuro is far from my speciality so I have no idea how to help them on this one!

Thanks in advance for any help!
 
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You cannot code the 95860/70 with the 95900-04 codes at all. That is why they are denying. without seeing the providers report I cannot say what the appropriate codes would be. FYI 2013 the NCV codes have been deleted, there are all new codes and instructions to the provider for the NCV, including the fact that the interpretation must be performed real-time while the patient is still there.
 
Debra, do you happen to have a link to the info about the changes to the NCV codes in 2013?
 
That link gives you the new codes, the CPT book gives you more detail, such as the interpretation must be performed real time, as in while the patient is still there for the test.
 
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