Neurology & Pain Management Coding Alert

Question: I have one neurologist that generates an EMG report directly from his observation when the testing is done, but there is no printout to refer back to. Is there anything in writing that statesthat there must be a printout/documentation when reporting an EMG/nerve conduction test? Will that change which codes I would use?

Wisconsin Subscriber

Answer: The neurologist should include clear documentation of all separate and distinct neuromuscular electrodiagnostic tests performed. The neurologist's documentation may be necessary for a payer appeal of any denied additional but medically necessary diagnostic studies.

Make sure your documentation supports the actual performance of each of the individual diagnostic tests performed. Payers will be alert for people who are using a nerve conduction study(NCS) as a screening test -- for example, if your office is testing every diabetic patient, you could be in trouble.

The lack of a printout may affect your ability to get paid, but it should not change which codes you use. Your neurologist's documentation should still indicate if it was an electromyography (EMG) test (95860-95872, Needle electromyography) or a nerve conduction study (95900-95904, Nerve conduction, amplitude and latency/velocity study, each nerve).

Remember that you can report only one of the codes when a neurologist performs the study on the same nerve at multiple sites.

Important: Make sure your documentation does include medical necessity, noting patient symptoms such as numbness, tingling, paresthesias, or muscle weakness that led to the test.

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.