Neurology & Pain Management Coding Alert

Question: Is it appropriate to bill muscle testing (with supporting documentation) on the same day as an EMG? The muscle testing CPT codes have a "separate procedure" notation, which I believe means that if they are done with a primary procedure, they cannot be billed separately. Is this correct?

Illinois Subscriber

 Answer: The "separate procedure" notation in the code descriptors for muscle testing codes 95831-95834 (and range-of-motion codes 95851-95852, as well as many others) indicates that you may report these procedures independently only if they are completely separate from other procedures the physician provides during the same visit. In other words, you should only report "separate procedures" if they are not performed as part of a more inclusive procedure.

 A quick way to determine whether to include a "separate procedure" in another procedure is to check the National Correct Coding Initiative (NCCI) edits. In this case, the NCCI does not bundle 95831-95834 to electromyography (EMG) codes 95860-95872. Therefore, you may report these procedures together: The muscle testing is "separate" from (not included in) the EMG testing. NCCI does bundle muscle testing to related procedures such as 97750 (Physical performance test or measurement [e.g., musculoskeletal, functional capacity], with written report, each 15 minutes).

 Reporting muscle testing with an E/M service is more confusing. CPT Assistant, published by the AMA, specifically instructs, "Codes 95831-95834 identify a test of muscle strength graded by examiner according to standardized grading scales. They describe manual testing based on numerical or verbal grading scales. If performed in addition to an evaluation and management service, they may be reported separately." But the NCCI (which is a product of CMS/Medicare) bundles muscle testing to all E/M services at every level (99201-99499), thereby suggesting that you may never report muscle testing separately with an E/M code. In this case, you must ask your payer whether it follows CPT or CMS recommendations prior to billing (all Medicare payers follow CMS guidelines). As always, be sure to get the payer's decision in writing.

  Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online codng certification training center based in Absecon, N.J.