Neurology & Pain Management Coding Alert

Question:  Our neurologist conducted electromyography study if 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]) specifics "muscles" (plural).  Therefore, you may report 95869 only once per session, regardless of the number of levels the neurologist tested. 

In addition, the CMS Physician Fee Schedule assigns a bilateral-procedure indicator of "0" to 95869, meaning that modifier 50 (Bilateral procedure) does not apply.

In this case, you should report a single unit of 95869, with no modifiers attached.

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.