Neurology & Pain Management Coding Alert

You can choose between needle EMG and muscle stimulation guidance

Great news for neurology practices: You-ll have two new-for-2006 CPT codes to describe guidance procedures with chemodenervation injections.

Thanks to the advocacy efforts of the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) and other groups, you won't lose the ability to report (and gain reimbursement for) these services.

Get Ready for a Switch on Jan. 1

For the remainder of 2005, you can continue to report 95870 (Needle electro-myography; 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) for electromyographic (EMG) guidance with chemo-denervation injections 64612-64614 (Chemodenervation of muscles-).

Caution: Some payers require that you report 95999 (Unlisted neurological or neuromuscular diagnostic procedure), rather than 95870, for EMG localization.

The problem: Medicare, through the National Correct Coding Initiative (NCCI), places severe restrictions on EMG code use with chemodenervation codes, and physicians have been concerned that they would lose the ability to bill for guidance entirely in 2006 if the AMA failed to deliver dedicated guidance codes.

Learn more: For complete information on NCCI edits limiting the use of guidance codes for chemodenervation, see -CMS Puts the Squeeze on EMG Guidance With Botox Injections- in the December 2004 Neurology Coding Alert.

The solution: When CPT 2006 becomes effective this January, you will be able to choose from one of two new add-on codes--instead of 95870 (or 95999)--to describe guidance with chemodenervation (Note that the exact five-digit code numbers have not yet been finalized but should appear soon. Keep an eye on Neurology Coding Alert for complete information when it becomes available.):
 
- +9585x--Electrical stimulation for guidance in conjunction with chemo-denervation (list separately in addition to code for primary procedure)

- +9585y--Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure).

Code 9585y, in particular, better describes guidance for chemodenervation than does 95870. -EMG guidance for chemodenervation is not really a diagnostic study as 95870 describes,- says Marvel J. Hammer RN, CPC, CHCO, president of MJH Consulting in Denver.

Dollars and Cents Will Make the Difference

Although dedicated codes to describe guidance for chemodenervation are a step in the right direction, some experts are withholding judgment, at least for now.

-The goodness or badness of the new codes is solely dependent on the associated RVUs [relative value units], and we won't know those for a while,- 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. In other words, if 9585x and 9585y won't pay, they won't be much of an improvement.

Report Only 1 Guidance Procedure per Claim

If the AMA's draft guidelines hold true, you should follow two rules when reporting 9585x and 9585y: 

1. The new codes describe add-on guidance procedures for use with 64612-64614 only. Revised instructions following the descriptors for 64612-64614 will specifically guide you to 9585x and 9585y codes -for chemodenervation guided by needle electromyography or muscle electrical stimulation.-

2. You cannot report both 9585x and 9585y during the same session.

In addition, CPT will instruct you not to report 9585x and 9585y with current EMG codes 95860-95870.
 
Stay tuned: The AMA will hold its CPT 2006 Coding Symposium Nov. 17-18 in Chicago, and will finalize its recommendations for CPT 2006 at that time. Look to Neurology Coding Alert for complete information on all the CPT changes that will affect your neurology practice.