Neurology & Pain Management Coding Alert
Reader Question ~ Extremities Drive Paraspinal Injection Coding
Question: Our neurologist performed a paraspinal thoracic electromyogram (EMG). He uses needles up and down the patient's spine and says he tested two arms and T1-T12. How should I code this encounter? Answer: A complete study of a single extremity (95860, Needle electromyography; one extremity with or without related paraspinal areas) requires evaluation of extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal and femoral, but not sub-branches) or four spinal levels, with a minimum of five muscles studied per limb.
Nevada Subscriber
The CPT code description for a single extremity includes the related paraspinal muscles. For an upper extremity EMG exam, that includes the cervical paraspinal muscles along with T1 and T2.
If your neurologist performed and documented the requirements for testing two upper extremity EMGs and the T3-T11 paraspinal muscles, you should report the services with 95861 (... two extremities with or without related paraspinal areas) and 95869 (... thoracic paraspinal muscles [excluding T1 or T12]).
According to Correct Coding Initiative (CCI) edits, 95869 is a component code of 95861 -- which means you wouldn't usually report the codes together because 95861 (as the comprehensive code) includes the service represented by 95869 (as the component code).
Coding exception: If your physician's documentation indicates that he performed the thoracic paraspinal testing in a separate and distinct location (not T1-T2) or during a different session, then the guidelines allow you to bypass the edit with modifier 59 (Distinct procedural service) and report both codes.
Neurology & Pain Management Coding Alert
- Documentation Details ~ Follow 4 Rules for Billing Multiple Nerve Conduction Studies
Simplify your NCS claims with this advice from the experts Multiple nerve conduction studies (NCS) [...] - Procedure Focus ~ Third Occipital Nerve Injections Shouldn't Give You a Headache
Hint: Home in on individual procedure steps to narrow options With three occipital nerves in [...] - You Be the Coder ~ Coding Observation in Non-Observation Unit
Question: Our physician performed an observation service on a patient who was not in the [...] - Reader Question ~ Divide to Conquer Prolonged Inpatient Service
Question: Medicare denies our claims for prolonged inpatient hospital services. We report 99232 and 99354. [...] - Reader Question ~ Follow-up Versus Discharge Depends on Timing
Question: When our physician discharges a patient, should we bill a hospital follow-up visit and [...] - Reader Question ~ 24-Hour EEG Applies to Test Time, Not Calendar
Question: One of our neurologists performs overnight electroencephalograms (EEGs) in the hospital setting. He monitors [...] - Reader Question ~ Watch Specific Guidelines Before Reporting 96116
Question: What guidelines apply to reporting 96116 with other tests?
Oregon Subscriber Answer: CMS has [...] - Reader Question ~ Check Documentation Before Appealing NCS
Question: We receive denials for 95900 whether we report it with or without modifier 59. [...] - Reader Question ~ Extremities Drive Paraspinal Injection Coding
Question: Our neurologist performed a paraspinal thoracic electromyogram (EMG). He uses needles up and down [...] - Reader Question ~ Carriers Might Balk at Multiple Units of 77002
Question: When we perform multiple injections at the same time, can we report 77002 more [...] - Reader Question ~ Report X-Ray Code if Mini C-Arm Stores Images
Question: Our clinic purchased a mini c-arm, and it is the only x-ray unit in [...]
