Neurology & Pain Management Coding Alert

CPT^® considers EMG secondary to NCS, so code appropriately.

Patients requiring needle electromyography (EMG) raise several coding challenges. First, you have to know how extensive the EMG is.

Then, you’ll have to decide whether to code for a nerve conduction study (NCS), which very often follows a needle EMG. These codes have some specific rules of their own, as well. Oh, and coding for an EMG completely changes when the provider also performs an NCS.

Read on for more information on the needle EMG/NCS coding combo, and get it right the first time on your claim.

Choose From 4 Codes for EMG Only

When your provider performs needle EMG, choose from one of the following codes, depending on encounter specifics:

• 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas)
• 95861 (… 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)

“There are many conditions that are diagnosed or monitored using EMG. Probably the most common would be carpel tunnel syndrome, but any condition that is the result of nerve compression or where there is nerve demyelination might include an EMG,” explains Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

Bucknam says they might also be used to diagnose or determine treatment options for herniated disc, amyotrophic lateral sclerosis (ALS), or myasthenia gravis (MG), or to find the cause of weakness, paralysis, or muscle twitching.

And those aren’t the only conditions that might prompt an EMG from your provider. For more information on how far EMGs go, see “Dx Codes List Is Vast for EMGs” on page 3.

Example: A patient presents to the practice with shooting pain from the right side of their neck down their right arm; they also report additional aching in their right elbow and some twitching of the fingers in their right hand. The provider orders an EMG of the right upper extremity and cervical paraspinal area. The testing neurologist’s interpretation confirms lateral epicondylitis of the right arm with no indication of cervical spine involvement. The patient will be managed by their primary care physician (PCP).

For this encounter, you should report 95860 for the EMG with M77.11 (Lateral epicondylitis, right elbow) appended to represent the patient’s tennis elbow.

Remember NCS — and Code for the Test

As previously mentioned, a needle EMG often leads to an NCS. When this occurs, coding will change; you’ll choose from the following codes for the NCS, depending on encounter specifics:

• 95907 (Nerve conduction studies; 1-2 studies)
• 95908 (… 3-4 studies)
• 95909 (… 5-6 studies)
• 95910 (… 7-8 studies)
• 95911 (… 9-10 studies)
• 95912 (… 11-12 studies)
• 95913 (… 13 or more studies)

Then, you’ll choose from the following add-on codes for the EMG, 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))
• +95887 (Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure))

Explanation: “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,” says Bucknam.

Consider this example from Bucknam: A patient presents with pain and numbness in both hands and wrists. They are a computer programmer and spend many hours a day using a mouse and keyboard, and the physician suspects a repetitive movement injury like CTS. The physician orders bilateral upper extremity EMG and NCS. Five nerve condition studies were performed in each arm and an EMG was also performed in each arm. Interpretation of test results confirms bilateral mild CTS. The patient will be treated by their PCP.

For this claim, you should report:

• 95911 for the NCS
• +95885 x 2 for the EMGs
• G56.01 (Carpal tunnel syndrome, right upper limb) and G56.02 (Carpal tunnel syndrome, left upper limb) appended to 95911 to represent the patient’s CTS
• G56.01 appended to the first instance of +95885 to represent the patient’s right-sided CTS
• G56.02 appended to the second instance of +95885 to represent the patient’s left-sided CTS.

Follow EMG/NCS Orders … or Risk Trouble

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, she should contact the ordering provider to amend or correct the order,” Bucknam relays.