Neurology & Pain Management Coding Alert

Question: Can I bill for both EMG and E/M services on the same day?

Michigan Subscriber

Answer: If your neurologist performed both services and properly documented medical necessity for both services, you can bill E/M services for the same patient on the same date as an EMG (Electromyography) or nerve conduction study (NCS).

If your neurologist performs and documents additional work that is not only separately identifiable from the pre- and post-diagnostic study work, but also meets the criteria of significant, then it is appropriate to append modifier 25 to the E/M code.

There are many instances when you would report E/M services on the same day with electrodiagnostic medicine codes, such as 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas) or 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study).

Neuromuscular electrodiagnostic testing typically includes the performance of a brief history and physical exam, which are necessary to determine what specific test(s) your neurologist should perform.

Justification: The CPT manual's "Neurology and Neuromuscular Procedures" section guidelines provide insight into the CPT rules about reporting E/M services along with neurological services such as EMGs:

"Neurologic services are typically consultative, and any of the levels of consultation (99241-99255) may be appropriate. In addition, services and skills outlined under Evaluation and Management levels of service appropriate to neurologic illnesses should be reported similarly."

Pointer: Proper modifier 25 use does not require a different diagnosis code. In fact, the presence of different diagnosis codes attached to the E/M and the diagnostic studies does not necessarily support a separately reportable E/M service. Your key to separately reporting the E/M service lies in whether your neurologist performed work beyond what is considered to be part of the diagnostic studies.