Neurology & Pain Management Coding Alert

Question: We submitted a claim with codes 95874, 95870, 64613, and J0585. The insurer paid for codes 64613 and J0585, but not 95874 and 95870. Should we have included modifier 59 on the other two codes?

New Mexico Subscriber

Answer: The issue is not one of modifier use, but NCCI edits and incorrect coding. Edits bundle code 95870 (Needle electromyography; limited study of muscles in 1 extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) as a component of 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) with no possibility to use a modifier to bypass the NCCI edit. In addition, edits bundle +95874 (Needle electromyography for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]) as a component of 95870 with no provision to append a modifier to bypass the bundling edit.

Based on the information you shared, you could submit a corrected claim. After review of the provider's documentation of the use of EMG as guidance for the chemodenervation injections, report 64613, +95874, and J0585 (Injection, onabotulinumtoxina, 1 unit).