Say my doc does a full EMG on a patient's lower extremites, but then only does the bilateral biceps and one other muscle on the upper extremities. That's 3 muscles, and you have to have 5 muscles on 1 limb to qualify for a "limb" EMG, but my billing service is telling me that you can't bill more than 1 unit for the limited study. Is that true? Does anyone know why? I'm looking at the EMG LCDs and the utilization section says "It is expected that these tests would be performed as indicated by current medical literature and/or standards of practice." and "The number of tests (units of each CPT code) performed should be the minimum needed to establish an accurate diagnosis. It then refers me to the coding guidlelines section for the number of tests which should not be exceeded. The coding guidelines section states that this will be discussed in the utilization section.

Does anyone have any neurology coding experience? This is the first neurologist in our area who actually performs these tests, so I'm learning as I go.

I did find one article that states Medicare expects 1 limited EMG per limb per session, but it wasn't published BY Medicare, so I'm not sure I should believe it.