Neurology & Pain Management Coding Alert

Question: Can we bill for an autonomic testing and EMG testing on the same day? We are willing to report autonomic testing with 93660, 95921, 95922, 95923 and EMG testing with 95885 and 95886.

Alaska Subscriber

Answer: You can bill for autonomic testing and EMG recording on the same day.  When doing so, make note of the following:

1.Codes 95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure]) and 95886 (Needle electromyography, ……complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure]) are add-on codes. You will also need to report the primary codes for nerve conduction studies (95907-95913).

2.Code 95922 (Testing of autonomic nervous system function; vasomotor adrenergic innervation [sympathetic adrenergic function], including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt) has CCI bundle with 93660 (Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention). If you have documentation that the autonomic nervous system function testing was separate and distinct from the cardiovascular function testing, i.e. performed at a separate encounter, then it would be appropriate to append a modifier with 95922 (column 2 code).

3. You cannot report codes 95921 (Testing of autonomic nervous system function; cardiovagal innervation [parasympathetic function], including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio) and 95922 together as per AMA’s instructions.