You Be the Coder:
Count Extremity for EMG, Nerves for NCS
Published on Sun Nov 25, 2012
Count Extremity for EMG, Nerves for NCS
Question:
Our neurologist completed an upper and lower extremity EMG and NCS on the same day. The diagnosis was the same for both extremities. How can we bill Medicare to avoid duplicate billing and rejection of the claim?
Ohio Subscriber
Answer:
It is not clear from your question if the NCS comprised the motor or sensory nerve testing. Depending upon the type of study (motor without F-wave, motor with F-wave, or sensory), you may report code 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study), or 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory). However, remember you cannot report multiple units if your clinician tests more than one place on a nerve. Report only a single code to represent testing multiple locations on a single nerve.
You will be billing on one line item for each type of NCS using the units of service field to indicate the total number of corresponding type of NCS. For example if the physician performed 2 sensory NCS on the UE and 1 on the LE, then the billing would be 95904 on a single line item and 3 units of service.
You may review the Table in Appendix J of the CPT
® codebook to identify the typical number of the various electrodiagnostic tests necessary for each of the conditions. If your provider performed more than indicated in the Table, your physician's documentation should include the medical necessity for the additional diagnostic tests. For example, for 90% of patients with a final diagnosis of polyneuropathy, the maximum number of sensory NCS was 4 units. If the physician determined he/she needed to perform a total of 6 sensory NCS on this particular patient to make a diagnosis of polyneuropathy, the physician's documentation should include the reason why it was necessary to perform the additional two sensory NCS. This may be necessary if the additional diagnostic testing is denied by the payer.
You may report 95903 and 95904 together as there is no bundling between these codes.
For the EMG, submit 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]) or 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]) depending upon the number of muscles studied. You report these codes only once per extremity. These are add-on codes, so you do not append modifier 59 (Distinct procedural service)..
