Neurology & Pain Management Coding Alert

How you report EMG and sleep studies makes all the difference

The latest National Correct Coding Initiative (NCCI) edits contain a few interesting items for neurology coders, so watch your electromyography (EMG) and sleep test claims.

Mutually Exclusive Edits Target Needle EMG

NCCI version 13.1 includes several mutually exclusive edit for neurology, focusing on EMG codes 95865 (Needle electromyography; larynx), 95866 (... hemidiaphragm) and 95868 (... cranial nerve supplied muscles, bilateral). E/M code 99455 (Work related or medical disability examination by the treating physician ...) also gets thrown into the mix.

The pairings include:

- 95865 with 95867 (... cranial nerve supplied muscle[s], unilateral), 95868 (- cranial nerve supplied muscles, bilateral) and 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)

- 95866 with 95867 and 95870

- 95868 with 95866

- 99455 with 99456 (Work related or medical disability examination by other than the treating physician ...).

These edits shouldn't be a surprise -- or change your work -- if you-ve coded neurology procedures for a while.

-There was built-in redundancy in the definitions of the new codes, so these edits that deal with 95867 and 95868 are quite reasonable,- says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside.


Nonmutual Edits Target T Codes, EMG

Nonmutually exclusive edits pair procedures that you cannot report separately when your physician performs them during the same session. NCCI edits establish one procedure of each pair as -comprehensive- and the other as -component.- The -comprehensive- procedure includes the services represented by the -component- code -- which is why you can't submit both procedures on the same claim.
NCCI 13.1 lists several sleep testing codes as the comprehensive part of edit pairs, then lists some EMG procedures as the component code of other pairs.

In the first set of edits, NCCI lists 0089T (Actigraphy testing, recording, analysis and interpretation [minimum of three-day recording]) as a component of:

- 95805 -- Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

- 95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist

- 95810 -- ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist

- 95811 -- ... sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist.

Additional edits list EMG codes 95865 and 95866 as components of motion analysis procedures 96002 (Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles), 96003 (Dynamic fine wire electromyelography, during walking or other functional activities, 1 muscle) and 96004 (Physician review and interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report).

In one final edit of interest to neurology groups, 90901 (Biofeedback training by any modality) is now a component of 95865 and 95866.

NCCI 13.1 is effective April 1 through June 30.