Neurology & Pain Management Coding Alert

Question: My neurologist performed an electromyography (EMG) on the laryngeal muscles via a special endotracheal tube with tracing electrodes. These measure one channel of EMG from both sides of the larynx. So this is bilateral monitoring with a single channel, but is it considered unilateral or bilateral cranial nerve EMG testing?

Washington Subscriber

Answer: The laryngeal muscles have innervation from the recurrent laryngeal nerves which originate from the vagus nerve (Cranial nerve X). Laryngeal EMG testing is used to diagnosis laryngeal movement disorders or evaluate trauma to the recurrent laryngeal nerves. Additionally they are often monitored during surgical procedures on the neck, including thyroid surgery. In 2006, CPT created a new code, 95865 (Needle electromyography; larynx) specifically for EMG testing of the larynx. According to the January 2007 CPT Assistant, physicians should report CPT code 95865 for this diagnostic study rather than either of the cranial nerve supplied muscle EMG codes, 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) or 95868 (-bilateral). Per CPT, 95865 is considered to be inherently bilateral and should not be reported with modifier 50.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.