Neurology & Pain Management Coding Alert

Question: My doctor has started doing EMG procedures/tests in an inpatient hospital setting. Should I report these EMG tests any differently than when he performed this service in our office?

New Mexico Subscriber

Answer: The codes you'll use for the procedures will be the same: electromyography (EMG) codes 95860- 95872 (Needle electromyography ...). You do, however, need to append modifier 26 (Professional component) to the EMG code. This indicates you are billing only for the professional component (the interpretation of the test). You should be clear for this portion of the diagnostic study as long as your documentation proves the payer's requirements, such as medical necessity.

Technical component: If your neurologist provides all of the technical components of the test -- the computer, supplies, and other equipment -- in addition to performing the test, you should contact the facility for reimbursement rather than bill your payer. You will need to clarify where, or to whom, you should send the bill. You will also need to confirm whether the facility wants a 1500 form or an invoice. It's beneficial for both parties that, if they do enter into a contract, it is agreed upon before the studies are performed.

Medicare and some other payers will reimburse the facility based on the patient's diagnosis while at that facility, using a method known as Diagnosis Related Groupers (DRG). The facility receives a payment, which includes allowances for the technical component of all diagnostic studies performed.

This includes the technical component of EMG studies, nerve conduction studies, and other tests performed by an independent physician using their own equipment. It's important to note that you cannot and will not receive a separate payment from Medicare or these other payers for the technical component, because it is already included in the allowance to the facility.