Neurology & Pain Management Coding Alert

To report 95860-95864 the neurologist must evaluate extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal or femoral - but not sub-branches) or four spinal levels, with a minimum of five muscles studied per limb, according to CMS guidelines posted in the Oct. 31, 1997, Federal Register.

The "related paraspinal areas" mentioned in code descriptors 95860-95864 include all paraspinals except those of the thoracic (T3-T11) region.

Therefore, you should not report paraspinal-area testing separately with 95860-95864 unless the physician studies those between T3-T11, in which case 95869 (Needle electromyography; thoracic paraspinal muscles [excluding T1 or T12]) is applicable.  

A limited study occurs when the neurologist tests fewer than five muscles per extremity. In these cases, you should choose 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinals, cranial nerve supplied muscles, or sphincters).

You may also report 95870 for EMG testing of muscles on the thorax or abdomen (unilateral or bilateral). When studying cervical or lumbar paraspinal muscles (unilateral or bilateral), claim only a single unit of 95870 regardless of the number of levels tested.

And do not report 95870 when the neurologist tests the paraspinal muscles corresponding to an extremity (for example, when also billing 95860-95864) because this would constitute double-billing.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.