Neurology & Pain Management Coding Alert

Question: Our physician performed a consultation one day, and the next day another physician in our group wanted to perform an EMG on the patient. The hospital does not have EMG equipment. Can the patient come from the hospital to our office for the procedure, or can our physician take the equipment to the hospital and charge for the service?


Missouri Subscriber

Answer: Either option is viable, depending on which works better.

If the hospital transports the patient to your office, bill the EMG with the correct site-specific choice (such as 95860, Needle electromyography; one extremity with or without related paraspinal areas) and include a note stating the physician performed the EMG as an ambulatory service. 

If your physician takes his portable unit to the hospital, report the same EMG code but verify whether you should also include modifiers. For example, some carriers stipulate that you cannot bill for the technical component even though you use your own equipment, which means you should append modifier 26 (Professional component).

Medicare pays for either approach to the EMG, but some commercial carriers might deny claims when you perform the test as an ambulatory service. Have sufficient documentation in place so you-re prepared to appeal any denials.