Neurology & Pain Management Coding Alert

Question: We don't know the best way to report transcranial motor evoked potentials for external anal and urethral sphincter muscle monitoring. The AAN's "Principles of Coding for Intraoperative Neurophysiologic Monitoring (IOM) and Testing" recommends 95870, but that's an EMG code and I'm not sure it applies to sphincter muscles.　Does CPT® have a better code that we missed?

Nebraska Subscriber

Answer: CPT® does not have a specific code for transcranial motor evoked potential testing of the sphincter muscles. You're also correct that code 95870 (Needle electromyography; limited study of muscles in 1 extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) might not be the best choice, because the descriptor states to not report 95870 for needle EMG of sphincter muscles.

Option: Check with the neurologist to learn whether she performed EMG testing of the anal/urethral sphincter muscles (the baseline intraoperative study typically is an EMG of either the rectal sphincter or urethra sphincter muscles rather than a motor evoked potential study). If so, you could report a choice from the 5178x code family, depending on whether the physician used a needle for the EMG testing. Two possibilities include 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) for non-needle EMG testing (often referred to as "sponge" electrode) or 51785 (Needle electromyography studies [EMG] of anal or urethral sphincter, any technique) for needle EMG.

Explanation: Needle electromyography (EMG) refers to the recording and study of the electrical activity of muscles using oscilloscope tracings and characteristic sounds produced by the electrical potentials. The physician makes recordings during needle insertion, with the muscle at rest, and during contraction. Needle EMG studies are interpreted in real time, as they are being performed.