Avoid EMG Coding Problems and Audits With Proper Documentation Techniques
Published on Sat Jan 01, 2000
Interpreting electromyograms (EMG) results can be complex. Consequently, coding for this procedure can cause billing problems that may lead to audits. Clearly documenting the studys results and medical necessity should ensure maximum reimbursement.
Neurologists use EMGs to provide a medical diagnosis by studying the electrical properties of skeletal muscles, but they may face problems when billing for the procedure. For example, a patient complains of pain originating in the neck that shoots down her right arm and is diagnosed with cervical radiculitis (723.4). The neurologist orders several tests, including nerve conduction studies and a needle EMG. The nerve conduction studies consist of a median and ulnar sensory (95904 two units) and a median and ulnar motor (95900 two units). The needle EMG (95860) is then performed.
Kim Bunch, REDT, senior EMG technologist, Department of Neurology, Medical College of Georgia in Augusta, Ga., explains that neurologists use EMGs to provide a medical diagnosis based on the recording and study of the electrical properties of skeletal muscle. The needle EMG, for example, is an invasive procedure using needles with electrodes to measure nerve and muscle function that may assist in the diagnosis of neuromuscular conditions. Use of a needle EMG also may assist in the diagnosis of neuromuscular conditions. A basis for the diagnosis is formed during the performance of the test when the data is collected and interpreted. A needle EMG examination is not performed in the same way on every patient but is tailored to the symptoms and signs of the patient undergoing the examination.
In addition, Bunch says, the sounds and waveforms produced by a needle EMG examination must be interpreted as they occur in real time. Although the raw data collected during a needle EMG provides information used to make a diagnosis. There are other significant factors, which include:
1. the exact location of the EMG needle electrode insertion sites in the patients body;
2. the auditory output of the electromyograph during the examination; and
3. the correlation between the recorded waveforms and the patients effort during voluntary muscular contraction.
Additional history and physical examination performed on a patient by the physician can often change the diagnosis or scope of the tests, Bunch notes.
Because interpreting the results of an EMG is complex, billing problems often develop that could lead to audits. Claims may not be paid because the EMG report was not sent with the claim, the tests medical necessity was not shown, the carrier may view the performance of more than one EMG on a patient as a duplication of services, or the carrier may claim that the person who performed the procedure was not properly trained.
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