Neurology & Pain Management Coding Alert

Answer: According to HCFA guidelines, to bill an EMG study of a complete limb (95860-95864 needle electromyography, one, two, three and four extremities with or without related paraspinal areas), you need to test at least five muscles that survey either three different nerves or four different spinal root levels. In other words, the EMG of a limb consists of the study of five muscles that are either innervated by three nerves or by four spinal levels.

If you are studying fewer than five muscles, 95870, which is a limited study. should be billed. This national Medicare policy is published in the Federal Register of Oct. 31, 1997, Vol. 62, No. 211, pg. 59090: To bill 95860-95864, extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal, femoral, not sub branches) or four spinal levels must be evaluated, with a minimum of five muscles studied.

Proper reading of this sentence takes note that the or applies to fulfilling either what comes before it (three nerves) or after it (four spinal levels), whereas the comma indicates that the requirement of studying five muscles is separate and applies to both (or all studies that are billed under these codes). This interpretation has been confirmed by a physician who assisted HCFA in writing the CPT codes and the requirements.

The following is one way to test five muscles that fulfills both options of the second requirement (innervated by three nerves or four spinal levels):

Deltoid (axillary nerve, C56)
Biceps (musculocutaneous, C56)
Pronator teres (median nerve, C67)
Triceps (radial nerve, C678)
First dorsal interosseous (ulnar, C8T1)

This tests four spinal levels (C5 through C8) and also tests five different nerves.

Conceivably you could test four spinal levels (C6 through T1) looking only at two nerves (median and axillary nerves). Below is an example of this scenario that fulfills the requirements for billing 95860-95864:

Pronator (median, C67)
Flexor Pollicis Longus (median, C78T1)
Abductor Pollicis Brevis (median, C8T1)
Deltoid (axillary, C56)
Teres Minor (axillary, C56)

You could also test at least three nerves but only a limited number of spinal roots, and still be able to bill 95860-95864:

Deltoid (axillary, C56)
Biceps (musculocutaneous, C56)
Supinator (radial, C56)
Supraspinatus (suprascapular, C56)
Pronator teres (median, C67)

If you have questions, please check with your local Medicare carrier.

Answered by Tiffany Z. Eggers, JD, MPA, policy director/ legislative counsel for the American Association of Electrodiagnostic Medicine in Rochester, Minn.