Neurology & Pain Management Coding Alert
Stick With 1 Unit of 95869
Question: Our neurologist conducted electro-myography study of the thoracic paraspinal muscles bilaterally at levels T3 and T4. I reported 95869-50 x 2 but Medicare rejected the claim. Is this correct?
New York Subscriber
Answer: You selected the appropriate code, but you reported too many units.
The descriptor for 95869 (Needle electromyography; thoracic paraspinal muscles [excluding T1 or T12]) specifies "muscles" (plural). For this reason, you may report 95869 only once per session, regardless of the number of levels tested.
And the CMS Physician Fee Schedule assigns a bilateral-procedure indicator of "0" to 95869, meaning that modifier 50 (Bilateral procedure) does not apply. You cannot receive additional reimbursement for bilateral testing.
In this case, you should report a single unit of 95869, with no modifiers attached.
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