Wiki EMG's

[Jennifer17]

This is new for me in orthopaedics , we are having a company come in periodically to perform EMG's and from what I understand the norm is to do them bilaterally, my question is if patient presents with symptoms of the left wrist lets say - how do you go about getting prior auth if needed for bilateral when patient was only seen for 1 side? is there a comparison daignosis code to use or somthing? any advise is greatly appreciated

Thanks!

 

[cpc2007]

I would query your ordering physician to see what the indication is for performing the bilateral EMG. Physicians can perform unilateral EMGs if the symptoms are only on one side so if they are looking at both sides, I would suspect there are symptoms on the right as well that may not have been mentioned in the order/record. Since medical necessity is the overarching criteria for any service per CMS and other payers often follow their lead, I would definitely ask the physician to make sure all details to support medical necessity have been documented and in turn considered by the payer.

Kim
www.codingmastery.com

 

[marvelh]

In some cases, the unilateral findings are "not quite normal" but not definitively abnormal. The physician may elect to do some additional EMG / NCS testing on the contralateral asymptomatic limb to determine if the symptomatic limb findings are indeed normal for that patient or are early symptoms of a problem.

The following is an excerpt from the American Association of Neuromuscular Electrodiagnostic Medicine's model policy: https://www.aanem.org/getmedia/65934187-d91e-4336-9f3c-50522449e565/Model-Policy.pdf
It should be noted that in some situations it is necessary to test an asymptomatic contralateral limb to establish normative values for an individual patient. Normal values based on the general population alone are less sensitive than this approach; therefore restrictions on contralateral asymptomatic limb testing will reduce the sensitivity of electrodiagnostic tests

Many payers use the AANEM's policy as a basis for their coverage policies, particularly the Maximum Number of Tests Necessary in 90% of Cases table.