Neurology & Pain Management Coding Alert

Question: We know that coding edits bundle 95913 and 95864. We read on a list serv that we could report modifier 59 with the 95913 to get it to pay. Is there a scenario where we are able to bill both on the same day? If so, when and how? 

Mississippi Subscriber 

Answer: You’re correct about the coding edit. Code 95913 (Nerve conduction studies; 13 or more studies) is a Column 2 code of 95864 (Needle electromyography; 4 extremities with or without related paraspinal areas). However, you cannot append a modifier to break the pairing and report both codes.  The CCI edits indicates that there is a “0” modifier indicator which means these codes cannot be billed together under any circumstances.

If you’re billing an EMG with nerve conduction study, you should submit +95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure]) or +95886 (… complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure]) instead of 95864.  The CPT® section guidelines state:

Use EMG codes (95860-95864 and 95867-95870) when no nerve conduction studies (95907-95913) are performed on that day. Use 95885, 95886, and 95887 for EMG services when nerve conduction studies (95907-95913) are performed in conjunction with EMG on the same day. 

Code 95864 should only be billed when the physician performs an EMG without nerve conduction studies on that day.