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Coding Class: 5 Tips Beef Up Your EMG Reimbursement

Pinpoint muscles to guarantee success

If choosing among the numerous electromyography (EMG) codes feels like a tough workout, take a breather: All you really need is to identify the specific muscles the physician tested, and you'll be well on the way to selecting the correct code. Follow these five tips to recoup hard-earned reimbursement for EMGs.

1. Count Limbs for 95860-95864
For needle EMG of the arms and legs, CPT offers four codes, depending on the number of extremities the physician studies:

95860 -- Needle electromyography; one extremity with or without related paraspinal areas
95861 -- ... two extremities
95863 -- ... three extremities
95864 -- ... four extremities.
For instance, if the physician evaluates both the left and right arms at the wrist to test for bilateral carpal tunnel syndrome, report 95861. For testing of both legs and one arm, such as during diabetes-related neuropathy evaluations, report 95863.
 
In all cases, the physician must evaluate extremity muscles innervated by three nerves, such as radial, ulnar, median, tibial, peroneal or femoral (but not sub-branches), or four spinal levels, while studying a minimum of five muscles per limb, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. "Medicare guidelines are very specific about the number of muscles required per limb," he says. "Coders should ensure the physician has clearly listed the number and names of the muscles tested in the medical record to sustain the claim."
 
A single unit of 95860, 95861, 95863 or 95864 includes all muscles of five or more tested in a particular extremity(ies). Report only a single unit of 95860-95864 per session: You cannot bill additional units for more than five muscles per extremity. If the physician studies or documents fewer than five muscles per limb, report a limited study (95870) rather than 95860-95864, says Tiffany Schmidt, JD, policy director for the American Association of Electrodiagnostic Medicine (AAEM).
 
Because 95860-95864 include testing of related paraspinal muscles, don't report paraspinal testing separately unless the physician studies those levels from T3 to T11 (inclusive). In this case, you may report 95869, according to AAEM recommendations. Likewise, if the physician fails to test related paraspinal muscles, this does not constitute a reduced or discontinued service -- so don't append any modifiers.
2. Supplied by Cranial Nerve? Choose 95867-95868
When coding for electromyographic testing of one or more muscles supplied by the cranial nerves, report either 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) for one side of the body or 95868 (... bilateral) for both sides of [...]

- Published on 2004-05-17