Neurology & Pain Management Coding Alert

Question: Can we code separately for the technician conducting the EMG and the neurologist performing the interpretation?
             
Nebraska Subscriber
 
Answer: Code 95860 (needle electromyography, one extremity with or without related paraspinal areas), as well as other related needle electromyography (EMG) codes, describes the test and the interpretation of the results. To bill for the technical and professional components of EMGs (95860-95870), the EMG must be done in the office, using equipment owned by the practice. 
 
If the EMG was performed somewhere other than the practice, in a hospital for example, report the EMG using 95860-95870 with modifier -26 (professional component) to indicate that the physician performed the interpretation only. The professional component must include a detailed interpretative report from the physician that specifies his or her findings. Simply recording the results is not sufficient for proving the professional component -- the chart note must explain what the results mean.
 
Ask your carriers what kind of report they expect to receive and how often an EMG test can be performed. Some will want to see only the medical-necessity documentation, but others will want the raw data, the interpretation and the medical necessity including the case notes used to decide to perform an EMG. Also, some carriers may limit the number of tests that the neurologist may perform for the same diagnosis within a certain time.