Neurology & Pain Management Coding Alert

Question: The neurologist documented an EMG study the following way: 

Muscle tested: Deltoid L, Infraspinatus L, Biceps brachi L, 1st dorsal interosseous L, C5 paraspinal L and C6 paraspinal L. 

He conducted the study along with NCS. One of our coders says it supports +95885 but the other coder says it should be +95886. Which is correct?

Wyoming Subscriber

Answer: The correct choice is +95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure]). That’s because the documentation shows the physician performed the EMG study on more than five muscles which were innervated by three or more nerves. Code +95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure]), by contrast, is for a more limited EMG study. 

Remember to also report the appropriate primary code for the nerve conduction study (NCS).  According to CPT® guidelines, these can include: 

• 95907 – Nerve conduction studies; 1-2 studies 

• 95908 – … 3-4 studies 

• 95909 – … 5-6 studies 

• 95910 – … 7-8 studies 

• 95911 – … 9-10 studies 

• 95912 – … 11-12 studies 

• 95913 – … 13 or more studies. 

Also remember that CPT® stipulates several codes that you cannot report with +95886. These include 95860-95864 (Needle electromyography … with or without paraspinal areas), 95870 (Needle electromyography; limited study of muscles in 1 extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters), and 95905 (Motor and/or sensory nerve conduction, using preconfigured electrode array[s], amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report). 

Final note: EMG testing of the paraspinal muscles can be “counted” as one of the five required muscles for a complete study, according to the December 2010 CPT® Assistant. This stance was published before these new add-on were created but the underlying concept remains the same, in that the paraspinal muscles can be counted toward the five muscle requirement.