Dont Be Shocked! Number of Muscles Tested, Area and Frequency Affect Payment for EMGs
Published on Fri Feb 01, 2002
Neurologists regularly provide electromyography (EMG) testing (95860-95872) to help diagnose a variety of conditions including carpal tunnel syndrome (CTS), muscular dystrophy and peripheral neuropathy. Although these codes are billed often, many providers still have difficulty in receiving proper reimbursement. Problems may arise because insurers reject the tests as medically unnecessary. In other cases, the provider may be unsure how many muscles must be studied per limb to report the EMG codes, or if it is appropriate to report a limited study of specific muscles multiple times for each muscle. Fortunately, the American Association of Electrodiagnostic Medicine (AAEM) and Medicare provide information that can aid in dealing with these challenges.
EMG Basics
Needle EMG is the recording and study of electrical activity of muscle using a needle electrode, says Steven W. Dibert, MD, a neurologist at the Neuroscience and Spine Center in Gastonia, N.C., and a member of the board of directors of the American Society of Neuroimaging and the board of the American Academy of Neurology/Neuroimaging Section. Specifically, EMGs test the electrical activity of skeletal muscle. The tests detect disorders affecting the muscles, but can also diagnose problems caused by other diseases, such as nerve dysfunction.
To perform an EMG, the neurologist places a needle electrode into skeletal muscle and measures muscle response at rest, during mild voluntary contraction, and during maximal contraction, Dibert says. Results are displayed on an oscilloscope as an electrical waveform. An amplifier is also used so the electrical activity can be heard as well as seen. Applicable codes include:
95860 needle electromyography, one extremity with or without related paraspinal areas
95861 two extremities
95863 three extremities
95864 four extremities
95867 cranial nerve supplied muscles, unilateral
95868 bilateral
95869 needle electromyography; thoracic paraspinal muscles
95870 ... 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
95872 needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied.
Note: Code 95875 (ischemic limb exercise test with serial specimen[s] acquisition for muscle metabolite[s]) was revised in 2002 and no longer specifies "electromyography." The new definition more accurately reflects current clinical practice. Also, a "surface" EMG (95999, unlisted neurological or neuromuscular diagnostic procedure) that uses a probe that is passed over the surface of the skin to measure electrical muscle activity is not the same as a conventional EMG. This method of EMG testing is considered investigational and is not covered by Medicare and most private payers.
The neurologist documents and interprets both normal and abnormal findings discovered during the study. Dibert advises that the report should indicate the muscles tested (number and location), [...]
