Neurology & Pain Management Coding Alert

Question: If the neurologist performs an EMGNCV (electromyography/nerve conduction velocity) with an F-wave study to the ulnar median nerve at the wrist, how would it be coded? Would modifier -59 come into play? Also, insurance carriers request a narrative with each billing. How much detail should be given?

Indiana Subscriber

Answer: Laurie Castillo, MA, CPC, president of Physician Coding and Compliance Consulting in Manassas, Va., and a coding expert in neurology, says Medicares policy regarding the use of codes for EMG/NCV testing with F-wave was updated recently. Code 95903 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) includes the services of a test without an F-wave study (95900); as such, it should not be used with 95903. If one nerve is tested without an F-wave study (95900) and a different nerve is tested with an F-wave study (95903), however, report both codes with modifier -59 (distinct procedural service) appended to 95903.

The patients medical record should document the medical necessity of the test. Data gathered during the nerve conduction study, such as the actual numbers (latency, amplitude, etc.), preferably in a tabular (not narrative) format, should be available to the carrier. The reason for the referral and a clear diagnostic impression are required for each study.

For needle EMG codes 95860-95864, only one unit of service should be billed. Neurologists should choose the code depending on how many extremities are going to be needled. Code 95860 is used for one extremity, 95861 for two extremities, 95863 for three extremities, and 95864 for all four extremities. This covers all muscles tested, including the related paraspinal muscles and recording of motor unit recruitment, amplitude and configuration both at rest and with muscle contraction. Code 95870 should be used to bill for distal muscles only, such as intrinsic foot or hand muscles.

To bill codes 95860-95864, a minimum of five muscles must be studied. For example, extremity muscles innervated by three nerves (radial, ulnar, median, tibial, peroneal, femoral, not sub branches) or four spinal levels evaluated.

When fewer than five muscles are examined per one extremity, use code 95870 (needle electromyography, limited study). It also can be used for examining muscles on the thorax or abdomen (unilateral or bilateral). One unit may be billed for studying cervical or lumbar paraspinal muscles (unilateral or bilateral), regardless of the number of levels tested. This code should not be billed when the paraspinal muscles corresponding to an extremity are tested and when the extremity codes 95860, 95861, 95863 or 95864 also are billed.

It is advisable for the neurologist to double-check this information with his or her top five carriers to ensure that state-to-state or carrier-to-carrier variations in policy for this procedure are not in place.