Neurology & Pain Management Coding Alert

Question: I am billing our carrier for EMGs and nerve conduction studies and am unsure of how to code for multiple units. Should modifiers be used? For example, should I code 95904 R & L? I have also been told by carriers that 95903 is not a valid code. Is this true?

Sherry Walker
Neurology Consultants of Dallas

Answer: When billing for EMGs (95860-95864) you need to consider the number of extremities tested and if it is unilateral or bilateral. For most Medicare and many third-party payers, unilateral EMGs require the -LT or -RT modifier. Code 95867 is for a needle EMG, cranial nerve supplied muscles, unilateral, so no left (-LT) or right (-RT) modifier is needed. Code 95868 is for needle EMG cranial nerve supplied muscles, bilateral, so modifier -50 (bilateral procedure) is not necessary. Code 95869 is for EMG testing of the thoracic paraspinal muscles, while 95870 is used for needle EMG limited study of muscles in one extremity or non-limb muscles (unilateral or bilateral) other than thoracic paraspinal, cranial nerve supplied muscles or sphincters. There are a limited number of ICD-9 codes that most payers do not consider to support the medical necessity for performing these EMGs. Check your local medical review policy listed on the Web site of your local Medicare carrier for a list of these codes. Make sure you ask the carrier if the diagnosis you plan to use is acceptable.

Code 95903 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) is a valid code, according to CPT 2001. It can only be charged once when multiple nerve conduction studies are performed on the same nerve. The same applies to 95900 (nerve conduction study without F-wave study) and 95904 (nerve conduction study, sensory or mixed).

However, when multiple nerve conduction studies, with or without F-wave study, are conducted on different nerves during the same session, these studies can be charged based on the number of nerves. This figure would then be converted to units on the HFCA 1500 claim, i.e., three different nerves that had nerve conduction studies motor with F-wave study would be 95903 x 3 units.

A sensory or mixed nerve conduction study, 95904, is often done on the same nerve with a motor nerve study, 95900 or 95903. Payers often do not understand the difference between these two and often deny paying for both. Submit documentation with the claim outlining the differences and various conclusions from the two nerve conduction studies, and show medical necessity.


Questions answered by Laureen Jandroep, CPC, CCS-P, owner/consultant of A+ Medical Management & Education Inc. in Egg Harbor City, N.J.; Neil A. Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside in Pittsburgh; and Catherine Brink, CPC, CMM, principal of HealthCare Resource Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J.