Neurology & Pain Management Coding Alert

Question: What is the best method to report 95870 in three muscles of each arm (bilaterally)?

Oklahoma Subscriber

Answer: You should report limited muscle studies (95870, Needle electromyography; 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) per limb. Therefore, when testing two extremities, report 95870 and place a 2 in the units box of the CMS-1500 or other claim form. If the tests are provided in a facility setting or using equipment not belonging to the reporting physician, you should append modifier -26 (Professional component) to the EMG code.
 
According to Medicare's 2003 Physician Fee Schedule, modifier -50 (Bilateral procedure) is not appropriate to 95870. When billing for multiple limbs, however, you may choose to attach modifiers -LT (Left side) and -RT (Right side) to specify that the neurologist tested different limbs. Alternatively, you may append modifier -59 (Distinct procedural service) to the second and subsequent units of 95870 to specify that testing occurred at several distinct anatomic locations.