Neurology & Pain Management Coding Alert

Do you know which codes go with EMG to complete NCS?

Patients reporting to your practice for an electromyography (EMG) of the extremities with nerve conduction study (NCS) can make a coder nervous if they’re not prepared for the claim.

The study includes two codes, which you’ll have to choose from two separate code sets. Failure to get both of these codes right could result in an adventure in miscoding.

But don’t fret; EMG/NCS reporting can be a breeze if you know what to look for and how to arrive at the proper code. Check out this expert EMG/NCS extremity advice before you file another claim for the study.

Part 1: Report the EMG Code

The first part of any EMG/NCS extremity study is an electromyography (EMG) of one or more extremities, confirms Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. This could be done to diagnose a variety of conditions.

“There are many conditions that are diagnosed or monitored using EMG. Probably the most common would be carpel tunnel syndrome [CTS], but any condition that is the result of nerve compression or where there is nerve demyelination might include an EMG,” she explains. EMGs “can also be used to help diagnose or determine the appropriate treatment for herniated disc, amyotrophic lateral sclerosis [ALS], or myasthenia gravis [MG] … or to find the cause of weakness, paralysis, or muscle twitching.”

When you report the EMG, you’ll choose from these codes, depending on encounter specifics:

• 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas)
• 95861 (Needle electromyography; 2 extremities with or without related paraspinal areas)
• 95863 (… 3 extremities with or without related paraspinal areas)
• 95864 (… 4 extremities with or without related paraspinal areas)

Part 2: Report the NCS Code

Once you’ve figured out the proper EMG code for your provider’s services, you’re ready to tackle the NCS portion of the claim.

“The EMG determines whether there is a breakdown in the communication between the nerve and the muscles, and the nerve conduction study tests how long it takes the nerve signal to travel to its destination and cause a muscle response,” Bucknam explains.

When your provider performs the NCS after the extremity EMG, you’ll choose from one of the following codes, depending on encounter specifics:

• +95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/ velocity study; limited (List separately in addition to code for primary procedure))
• +95886 (… complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to code for primary procedure))

Note: As CPT^® indicates in the codes themselves, these are add-on codes — not to be reported by themselves, only as a component of another service. Use of +95885 or +95886 without a primary procedure code will be met with suspicion and denial by payers.

Step 3: Remember the Orders

Bucknam reminds coders that they have to look in the provider’s orders to make sure the documentation is complete before submitting an EMG/NCS of the extremities. “One of the most frequent errors we see for billing these tests is that the ordering provider just orders an EMG when both an EMG and NCS are needed,” she says. “Less frequently we see only an NCS ordered when EMG is also needed.

“Many neurologists interpret these orders to mean ‘perform both tests when needed,’ but that is not acceptable from a billing and reimbursement standpoint. If these codes are audited, the payer will expect to see an order for each test to be performed.

“If only an EMG is ordered, only an EMG can be performed. If the neurologist feels that the patient needs additional studies to appropriately identify the condition, s/he should contact the ordering provider to amend or correct the order,” Bucknam relays.