Neurology & Pain Management Coding Alert

Question: I-ve been getting a denial using 95860-26 (Needle electromyography ...) alongside 95903-26 (Nerve conduction ...) or 95904-26 (Nerve conduction ...) stating that this is not paid separately when done with another procedure. Is this true?


Rhode Island Subscriber

Answer: This is a strange denial because the National Correct Coding Initiative (NCCI) does not bundle electromyography and nerve conduction studies. You should appeal, and use the new Appendix J in the CPT book to help with your appeal. Appendix J clearly shows that EMG testing is often necessary in combination with NCS to diagnose a patient's symptoms and complaints.

Keep in mind: Typically the diagnosis is the same for both types of electrodiagnostic testing, if the neurologist performed them at the same testing, whether it is needle EMG studies and/or NCS. The neurologist performs the selection of diagnostic tests and then determines a diagnosis based on the findings. If the study(ies) are normal, you would use the sign/symptom that was the indication for the tests originally.

No modifiers are necessary between the needle EMG codes and the NCS codes. There are some NCCI issues between the individual needle EMG codes and between the two motor NCS codes, but not between EMG and NCS.