Neurology & Pain Management Coding Alert

Have a documented request


If you're charging an E/M service every time the neurologist conducts electromyographic (EMG) testing, you may be overbilling.
 
In most cases, you cannot report an E/M service in addition to EMG when your neurologist treats patients referred by other physicians. In other words, if a patient arrives only for testing at the request of another physician, the neurologist cannot charge for a separate E/M service beyond that normally included as part of the EMG itself, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
 
Many Medicare local medical review policies specify that the neurologist cannot report an E/M service in addition to EMG unless the referring physician clearly requested an E/M service, Hammer says.
 
For example, a diabetic patient's primary-care physician (PCP) requests that the neurologist see the patient and perform EMG to evaluate possible neurological complications of diabetes. The neurologist will provide testing only and share the results with the PCP, but will not provide or charge for an E/M service in addition to the testing.
 
When a neurologist sees a new patient or a patient with a new complaint for the first time, and the patient was not specifically referred for testing by another physician, you may charge an E/M service. But you should make sure that the neurologist documents all the requirements of a given level of service. For example, a new patient sees the neurologist complaining of wrist pain and numbness. The neurologist performs an E/M service and provides electrodiagnostic testing (including EMG) to evaluate the patient for carpal tunnel. In this case, you may report an E/M service in addition to the testing if you append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M service code.