Neurology & Pain Management Coding Alert

For guidance with 64612-64614 and 64640, stick with 95870 only

CMS has changed the rules for billing chemo-denervation with needle electromyographic (EMG) guidance. At least until 2006, you should report only 95870 for EMG guidance with 64612-64614 and 64640.

National Correct Coding Initiative edits that went into affect April 1 limited the EMG codes that you could use with chemodenervation codes. And NCCI was scheduled to bundle the remaining EMG codes as of
Jan. 1, 2005.

After hearing arguments made by the American Association of Electrodiagnostic Medicine (AAEM), however, CMS has agreed to allow physicians to bill limited EMG studies with chemodenervation for a period of one year while the agency and physicians organizations research other methods of assuring reimbursement.

Therefore, you should no longer report chemo-denervation codes (64612-64614, 64640) with a needle EMG code unless you use 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), says Tiffany Schmidt, JD, policy director for the AAEM.

As a solution to this problem, CMS may allow for a new add-on CPT code to describe needle EMG with chemodenervation. To do this, the AAEM advised CMS that it would need to go through the AMA CPT process, which would take at least one year.

If CPT were to include a specific code to describe EMG guidance with chemodenervation, it would appear no sooner than 2006.