Neurology & Pain Management Coding Alert

Question: CPT 2000 makes a distinction between a limited electromyography (EMG) study of a single limb and a complete study, but there is no definition of each. When is it appropriate to bill one rather than the other?

Brad Haynes
Neurology Associates, PA, Hickory, N.C.

Answer: Code 95870 (needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) is used to report a limited study. Codes 95860 (needle electromyography, one extremity with or without related paraspinal areas), 95861 (needle electromyography, two extremities with or without related paraspinal areas), 95863 (needle electromyography, three extremities with or without related paraspinal areas), and 95864 (needle electromyography, four extremities with or without related paraspinal areas) are used to report complete studies of the extremities.

Tiffany Z. Eggers, JD, MPA, a policy analyst with the American Association of Electrodiagnostic Medicine (AAEM) in Rochester, Minn., says that the parameters under which a neurologist may bill a complete study are as follows: To report these codes, extremity muscles innervated by three nerves (e.g., radial ulnar, median, tibial, peroneal, femoral) or four spinal levels must be evaluated, with a minimum of five muscles studied.

EMG studies are sometimes run to help a neurologist map a particular area for muscular injections so that bones or nerves are not compromised. In this instance, limited study code 95870 is commonly used because fewer than five muscles are studied. The general rule is if less than five muscles are studied, the limited code is applied. It would be incorrect to code 95860 with a -52 modifier (reduced services) to indicate that fewer than five muscles were studied.

Complete EMG studies of the limbs generally are achieved by testing the paraspinal muscles then testing symptomatic and clinically asymptomatic muscles. Muscles with large surface areas often require the neurologist to examine several specific sites. Because many muscles are tested, a high percentage of EMG limb tests fall into the complete study category.