Neurology & Pain Management Coding Alert

Question: When CPT 95867 is used in combination with 95860 or 95861, should a modifier be added to indicate that it is a distinctly separate procedure?

Badr Ibrahim, MD.
Titusville, Fla.


Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: According to the National Correct Coding Initiative, codes 95860 (needle electromyography, one extremity with or without related paraspinal areas) and 95861 (needle electromyography, two extremities with or without related paraspinal areas) are not listed as component codes of 95867 (needle electromyography, cranial nerve supplied muscles, unilateral). No modifier such as -59 (distinct procedural service) should be needed to report 96867 with 95850 or 95861. If carriers deny these combined codes, mention in your appeal that these are separate procedures. 95867 is for cranial nerve innervated muscles (neck and face and tongue) and not limb muscles.

Answered by Catherine Brink, CMM, CPC, Principal, HealthCare Resource Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J.