Wiki EMG Confussion

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mshafr

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There is some confussion in our office to whether you can bill EMG's Services 95860 or 95861 with a 50 modifier? I also need clarification on whether you code the units per nerve or per needles used. Any help would be greatly appreciated.
 
EMGs

Good morning,

Not quite sure why there is even a question as to whether you can use a -50 modifier on either of those codes. There are 4 extremities and there are 4 codes...95860 is for an EMG of 1 extremity; 95861 is for 2 extremities; 95863 is for 3 extremities and 95864 is for 4 extremities. Therefore, there would never be need for a -50 modifier.

As for the rest of your question, need a little more info.
 
Modifier -51

Good morning Joyce,

I was hoping not to bug you again so soon. I have a
quick question, would you attach modifier -51 on EMG when your DR would perform it with NCV? I don't see an exempt but the previous billing company never attached it and I wasn't sure if there was a reason. Also, would you attach another 51 after motor NCV if Dr also did sensory NCV?

ex: 99243-25
95860-51
95903-26 -51 x4units
95904-26 x4 units

I really appreciate your help.
__________________
 
Thanks for your response as you see we are extremely lost with coding EMG's. The gentleman we have performing these studies says with other providers he is employed through he uses a 50 modifier on those codes 95860 and 95861. I doesnt make any sense to me either.
He also bills nerve conduction studies 95903 and 95904 based on how many needles he uses for placement rather than the nerves itself. Its my understanding that we can code for each nerve as 1 unit not based on the amount of needles used. am I correct on that? If he uses 5 needles he wants to bill for 5 units. Any help anyone can give us on EMG coding and nerve conduction studies coding as well would be greatly appreciated.
 
Response for Tara re: 51 modifier

Hi Tara,

Don't think you are bothering me...I think everyone on here is happy to help so ask away without the guilt :)

I do not believe that the -51 modifier would be necessary (or appropriate) in either scenario. EMGs and NCVs kind of go hand in hand and are separate and apart from each other. It's been a while and so I can't recall if the reimbursement is reduced on the subsequent procedures - I will have to do a little research into that part of it.

Please, again, feel free to ask any and all questions - if I can offer any insight, I am happy to do so.

Have a great day!

Joyce ;)
 
50 modifier issue...and EMG confusion

Good afternoon~

Since I am right in the middle of something right now, I will comment on the 50 modifier issue. I promise to get deeper into the needle portion ASAP.

I can't see the logic in "the others" using a -50 modifier when it breaks down to something so simple: if they are (for example), studying both the right and left upper extremities, why append -50 modifer when there is a code for 2 extremities? I think they are not seeing the fact that there are 4 very specific codes to remove any need for a bilateral modifier. I'm sure you will agree (as you already stated)...but good luck in convincing them of this - I know that sometimes it is like banging your head against a wall. What may be crystal clear to one may be muddy for another.

I will get back to you about the needle portion just as quickly as I can.

Thanks!

Joyce
 
In regards to the issue of billing 1 unit for each needle used ---no way. CPT guidelines state "Each nerve constitutes one unit of service." There is some helpful information in 2008 CPT book, in Appendix J.
Hope this helps.

Alaina:eek:
 
Also we need to remember that the 50 modifier is used for defined bilateral body parts or organs. Nerves are like skin there is no laterality. The nerves are all part of one continuous nervous tree if you will with different branches but no laterality. So you do not use RT or LT or 50. As to the units I have stated this many times that you should not bill these with units. I have observed many denials and down payments when units are used. The code states EACH nerve so each one is a unique site and therefore should be listed separately with its own line item. Yes your claim will have many pages but that it not an issue. I know that others will disagree and have been using units forever. But I did get one office to change and they noticed right away that the reimbursement overall began to increase on those claims where each nerve was separately listed.
 
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