Neurology & Pain Management Coding Alert

Getting reimbursed for electromyograms (EMGs) studies of the limbs, 95860-95870, is often difficult. This is because knowing how to bill for these is more than a simple matter of choosing the code which reflects how many limbs have been tested, says Barbara J. Cobuzzi, MBA, CPC, president of Cash Flow Solutions, a medical billing and coding consulting firm in Lakewood, N.J. Neurology coders need to be aware that carriers require a certain number of muscles to be tested in a given limb, and if that number is not met, the claim will be denied or reduced.

Identifying Proper Number of Muscles for Limb EMGs

To bill these codes, 95860, 95861, 95863 and 95864 (needle electromyography of 1, 2, 3, or 4 limbs with or without related paraspinal areas), the extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal, femoral, not sub-branches) or four spinal levels, a minimum of five muscles must be tested per limb. Documentation should be sent with the claims detailing exactly which muscles were tested so that the carrier will see that the requirement has been met.

For example, if the neurologist only tested two muscles in the right arm, it would not be appropriate to bill a 95860 even though an EMG to a single limb was performed. This is because less than five muscles were tested. If the neurologist tested five or more muscles in that arm, 95860 should be billed, accompanied by documentation.

If five muscles were tested in the left leg and six in the left arm, 95861 should be billed. Because you've met the five muscle requirement in each of the two limbs. However, if the neurologist tested three muscles in the left leg and six in the left arm, 95860, the code for a single extremity, should be billed. Because you have not me the five muscle requirement for each of the two limbs.

Limited EMG Studies of Specific Muscles

Cobuzzi states that coders sometimes make the mistake of billing for the limited study of specific muscles (95869 and 95870) multiple times for each, which is incorrect. HCFA has a policy on this, (see the Federal Register, Oct. 31, 1997, Vol.62, No. 211, page 59090) that clearly states that only one unit of these codes can be billed, despite the number of muscles studied or whether unilateral or bilateral tests are done. HCFA also states that 95869 (needle electromyography; thoracic paraspinal muscles) cannot be billed with 95860, 95861, 95863, or 95864 if only T1 and/or T2 are studied when an upper extremity is also evaluated.

Additionally, 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) should not be billed when the paraspinal muscles corresponding to an extremity are tested and when the extremity codes 95860, 95861, 95863, or 95864 are also billed.

Either of these coding practices would be considered double dipping.

CCI Bundles of EMG codes

Billing for multiple EMGs can be tricky, because of the prevalence of bundled test codes, which can result in payment reductions. A sample of bundled EMG codes, as reported in the Correct Coding Initiative (CCI), reveals that all codes for fewer extremities are bundled into the higher number extremity codes when attempting to report both. For example, you should not bill 95864 (needle electromyography, four extremities with or without related paraspinal areas) with 95861 (needle electromyography, two extremities with or without related paraspinal areas), because 95864 represents testing at more extremities than 95861, and is bundled with it. Additional bundles are as follows:

95867 (needle electromyography, cranial nerve supplied muscles, unilateral) includes 95869 because the paraspinal area is supplied by the cranial nerve.

95868 (needle electromyography, cranial nerve supplied muscles, bilateral) includes 95867 and 95869 because 95867 is a unilateral approach of the same muscles that 95868 tests bilaterally, and 95869 is a paraspinal area supplied by the cranial nerve.

Codes that Prompt EMG Studies

The additional history and physical can often change the diagnosis or scope of the tests, so the coder should verify the diagnosis before submitting the claim, explains Kim Bunch, REDT, senior EMG technologist, Department of Neurology, Medical College of Georgia in Augusta, Ga. Some experts recommend checking with carriers before performing an EMG, because of the small number of diagnosis codes that are approved. The word to keep in mind is precertification, says Cobuzzi, even if the diagnosis is on the list from Medicare.

Although the diagnosis prompting the EMG appears on the list of approved codes, you may still experience problems if a new diagnosis is not revealed. If the reason behind the test is 781.2 (abnormality of gait), yet the results did not show a more conclusive diagnosis, many carriers will not pay. If the claim is denied, you should appeal it with a copy of the carriers policy indicating 781.2 as covered. Also include a written explanation from the neurologist stating why the EMG was ordered.

The following is a partial list of ICD-9 codes from a sampling of local medical review policies that are usually accepted for supporting the medical necessity of EMGs. Please check with your local Medicare and third-party payers for a list of their approved codes before submitting for reimbursement.

333.6 idiopathic torsion dystonia
333.83 spasmodic torticollis
341.0 to 341.9 other demyelinating diseases of central nervous system
344.9 unspecified paralysis
350.1 to 350.9 trigeminal nerve disorders
351.0 to 351.9 facial nerve disorders
728.9 unspecified disorder of muscle, ligament, and fascia
952.00 to 952.9 spinal cord injury without evidence of spinal bone injury
953.0 to 953.9 injury to nerve roots and spinal plexus
954.0 to 954.9 injury to other nerve(s) of trunk, excluding shoulder and pelvic girdles
955.0 to 955.9 injury to peripheral nerve(s) of shoulder girdle and upper limb
956.0 to 956.9 ... pelvic girdle and lower limb
957.0 to 957.9 injury to other and unspecified nerves

Note: Part two of this article will appear in the May 2001 Neurology Coding Alert and will cover documentation, billing for E/Ms and EMGs on the same day, and coding for the professional and technical components.