Neurology & Pain Management Coding Alert

Question: When our neurologist monitored a patient's nerves during surgery, the electromyogram (EMG) diagnosis was different from the intraoperative monitoring (IOM) code. Which diagnosis should I use?

North Dakota Subscriber

Answer: You should report the same diagnosis you used to describe the medical necessity for the IOM. This is typically the diagnosis you use to establish the need for the surgery.

CPT: If the neurologist performs electrodiagnostic testing such as EMG, evoked potentials or nerve conduction studies, use 95860-95864 (Needle electromyography ...), 95925-95937 (Evoked potentials and reflex tests), 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), or 95904 (... sensory).

Case in point: If the patient undergoes lumbar spinal fusion at multiple levels due to lumbar spinal stenosis, the surgeon and anesthesiologist will probably use 721.4x (Thoracic or lumbar spondylosis with myelopathy). Therefore, the neurologist performing the baseline electrodiagnostic testing with IOM should also use 721.4x to explain medical necessity for the CPT codes he submits (including the baseline study and the IOM, +95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).