Wiki laryngeal EMG HELP PLEASE

[ONEALEA75]

A Laryngeal Electromyography is performed using both an otolaryngologist and a neurologist. The otolaryngologist places the needle electrodes; the neurologist operates the EMG machine, and both interpret the LEMG results.We are facility based so we will be appending modifier 26. The CPT code for the LEMG is 95865. Can/Should both providers bill for this 95865? possibly using the 80modifier?

 

[cpc2007]

It would be very atypical for an assist at surgery to be warranted on this procedure. The Medicare Physician Fee Schedule (MPFS) indicator for assist at surgery on CPT 95865 is "assist allowed with documentation." This means that Medicare would not typically expect an assist to be necessary for CPT 95865 but they don't preclude situations where an assist might be warranted. I work with a couple of very large neurology practices and have never seen support for an assist for a laryngeal EMG.

My suggestion would be to talk with your physicians to determine why two different providers were involved. If there's a compelling reason for both of them to work together to perform this procedure and that is noted in the reports (to support med necessity for your claim) you could attempt billing for one of the providers as an assistant. If they just worked together because one of them was already performing another procedure and got things started, and then the second physician took over, I would credit only one physician with full credit for 95865. Again I usually seek physician input on who should claim a procedure that cannot be split between two surgeons.

I hope that helps

Kim
www.codingmastery.com