Neurology & Pain Management Coding Alert

Question: Physicians often refer patients to our neurologists for EMGs. Our neurologist wants to spend some time talking with the patient beforehand and bill both an EMG and an office visit with 99213-25 and 95910. Will Medicare cover both services?

New Hampshire Subscriber

Answer: Electromyography diagnostic testing includes a low level history and physical exam in that the physician needs to determine what specific muscles and nerves that need to be tested based on the patient’s signs and symptoms. Medicare will reimburse for an E/M visit during the same encounter as an EMG or nerve conduction study if you have supporting documentation. You can bill for both services (E/M and EMG) if:

• The physician discusses another problem (unrelated to the EMG diagnostic study) with the patient and shows that this part of the visit is separate from the EMG.
• The patient comes for an office visit and the neurologist determines (and documents) that an EMG is necessary because of information gathered during the E/M portion. The physician should also perform additional medical decision making to support billing the E/M code (such as ordering physical therapy or changing prescription medications based on the results of diagnostic studies).
• The coding you suggest could be appropriate, depending on the circumstances. Select the EMG code based on the type of study completed (95860-95870 for a stand-alone EMG or +95885-+95887 for EMG performed in conjunction with NCS) and the E/M code based on the time and other factors involved. Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code to distinguish that care from the EMG.

Remember: If only the EMG is performed and that is the reason for the patient’s visit, then only bill the EMG.