Neurology & Pain Management Coding Alert

Question: We performed a full EMG on one extremity for radiculopathy and a limited EMG on another extremity for carpal tunnel syndrome. Should we bill 95861-52 for this? Also, can we bill 95870 x 3 if we do the EMG on three separate and distinct muscles? Would this require modifier -59?

Indiana Subscriber

 

Answer: Regarding the full EMG for radiculopathy (729.2) and the limited EMG for carpal tunnel (354.0), you should not bill 95861 (needle electromyography, two extremities with or without related paraspinal areas) with modifier -52 (reduced services). Using 95861 suggests that you performed a full EMG on two different extremities (which you did not), and modifier -52 would only confuse matters since CPT lists another code, 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) that more accurately describes a limited EMG. Therefore, in this situation, you would bill 95860 (needle electromyography, one extremity with or without related paraspinal areas) for the full EMG for radiculopathy and 95870 for the limited EMG for carpal tunnel syndrome.

 

You did not state whether all three muscles are on the same limb, but the assumption is that they are. Most providers will only reimburse 95870 on a per-limb basis, and therefore, if you tested three muscles on the same limb (for example, the left arm), you would bill 95870 only once. Modifier -59 (distinct procedural service) would not be necessary.