Neurology & Pain Management Coding Alert

Question: Using electromyography (EMG), the neurologist tested the thoracic paraspinal muscles bilaterally at levels T3 and T4. I reported 95869-50 x 2 with a diagnosis of thoracic radiculopathy [724.4]. Medicare rejected the claim. How should I have coded?

Michigan Subscriber

Answer: CPT 95869 (Needle electromyography; thoracic paraspinal muscles [excluding T1 or T12]) properly describes EMG testing of the thoracic paraspinal muscles, and your diagnosis is sufficient to establish medical necessity. But because the descriptor specifies "muscles" (plural), you may report this code only once per session, regardless of the number of levels tested. In addition, the CMS Physician Fee Schedule assigns a bilateral-procedure indicator of "0" to 95869, meaning that modifier -50 (Bilateral procedure) does not apply. You cannot receive additional reimbursement for bilateral testing.

In this case, therefore, proper coding is simply a single unit of 95869, with no modifiers attached.