Neurology & Pain Management Coding Alert

Question: If I want to report a certain procedure for which CPT does not include a specific code (e.g., surface electromyography), and I choose what I feel is the closest or next-best code, am I at risk of running afoul of compliance guidelines?

Utah Subscriber

Answer: The AMA and most experts advise against choosing the "next-best" CPT code when reporting procedures without a distinct code. Although you may contact individual carriers for instructions in some circumstances, generally if the service you provide is not included in CPT, the correct code choice is an unlisted-procedure code (for example, 95999, Unlisted neurological or neuromuscular diagnostic procedure).

Be sure to provide detailed documentation, including a narrative description, outlining the procedure and documenting the time involved. You may compare the procedure to the closest procedure listed in CPT for these purposes (it may speed payment to put this, along with the title of the operation, in box 19 of the CMS-1500 form). The payer will use this information to determine payment. The AMA has a toll-free number (800-634-6922) to call if you have questions about CPT. AMA members receive four free inquiries annually.