How To Correctly Code Your EMG Studies To Maximize Your Reimbursement?

Needle EMG is the recording and study of electrical activity of muscles using a needle electrode. Neurologists use EMGs to test the electrical activity of a skeletal muscle to provide a medical diagnosis on a patient. Although these are common procedures but coding them incorrectly can not only cause billing problems but often lead to audits.

The Centers for Medicare & Medicaid Services (CMS) outlines clearly its recommendations for EMG billing in the Federal Register (issue of October 31, 1997, Vol. 62, No. 211, page 59090), which covers some common questions like how many muscles should/need to be studied per limb in order to use the limb EMG codes or which code should be used when performing a limited study of a specific muscle and whether it can be used multiple times.

Here are some tips which can clarify EMG billing confusions and help in maximizing your EMG reimbursements:

1. When choosing an EMG code, count the limbs and identify the specific muscles the physician has tested. The first set of EMG CPT codes 95860-95864 are used on the basis of this analysis. To report these codes, the physician must evaluate extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal or femoral but not sub-branches) And a minimum of five muscles studied per limb.

For example: If a physician performs EMG test on a patient’s right leg and meets the minimum testing requirements (five muscles innervated by three nerves each), then he should report CPT 95860.

A single unit of 95860, 95861, 95863 or 95864 includes all muscles of five or more tested in a particular extremity(ies). In other words, one should report only a single unit of 95860-95864 per session: You cannot bill additional units for more than five muscles per extremity.

CPT 95865 is used for needle examination of the larynx and CPT 95866 is used for needle examination of the hemidiaphragm.

If fewer than five muscles are tested then CPT 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles or sphincters) should be used.

2. The next set of CPT codes are 95867-95868 which describes the EMG study of muscles supplied by the cranial nerve, either unilaterally or bilaterally. If the answer to your question is yes, then CPT 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateralOR CPT 95868 (Needle electromyography; cranial nerve supplied muscles, bilateral) should be used depending upon the test performed by the physician.

For example: A physician monitors the RLN (Recurrent Laryngeal Nerve) during a total thyroidectomy, he should assign the CPT 95868 for a bilateral EMG.

It is important to note that Codes 95867 and 95868 should not be reported together, nor should modifier -50 (bilateral procedure) be attached to CPT 95868.

3. Are studies performed on thoracic paraspinals other then those at T1 and T2? Then one must report CPT 95869 (Needle electromyography; thoracic paraspinal muscles).

Code 95869 is exclusively used to study thoracic paraspinal muscles between T3 and T11. One unit can be billed, despite the number of levels studied or whether unilateral or bilateral. 95869 cannot be reported with 95860-95864 if only the T1 and/or T2 levels are studied with an upper extremity. This code should be used if the examinations are confined to distal muscles only, such as intrinsic foot or hand muscles.

4. Is the study performed on fewer than five muscles per extremity, then CPT 95870 should be used. This code should only be used when the muscles tested do not fit more appropriately under any other CPT code. Code 95870 can be billed at one unit per extremity (one limb, arm or leg), when fewer than five muscles are examined.

For example: If a physician tests 3 muscles on the right arm and 4 muscles on the left arm, then code 95870 can be reported twice.

This code can also be used for examining non-limb (axial) muscles (e.g. intercostal, abdominal wall, cervical and lumbar paraspinal muscles (unilateral or bilateral)) regardless of the number of level tested. However, it should not be billed when the paraspinal muscles corresponding to extremity are tested, and when the extremity codes 95860, 95861, 95863, or 95864 are reported.

5. The last in row is code 95872 which is (Needle electromyography using single
fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied). This code should be used when a physician studies the action potentials (APs) from individual muscle fibers.

One should report one unit of 95872 for each muscle the physician tests. The physician will generally test at least two muscles (one test serves as a “control”), so you will report a minimum of two units of service. When  reporting CPT 95872, the physician must document the muscle(s) tested and the test results.

Keep these tips handy when coding and billing EMG studies. As always, please consult your payer guidelines and state regulations for any specific rules.

For recent changes in Nerve Conduction Study Codes 2013, please visit our latest blog post

Recent Changes to Nerve Conduction Codes

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