You Be the Coder:
Muscle Testing
Published on Sat Apr 01, 2000
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Can the neurologist bill for performing a nerve conduction study, a needle EMG, and muscle strength testing on a patient in the same session? If so, how would I code for this? Also, if the neurologist is asked to see a patient in the emergency room for a consult how should it be coded for optimum ethical reimbursement? Could you also give an example for using the critical care code 99291?
Tri State Neurology Center
Hagerstown, Md.
Answer: Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, says that according to the Correct Coding Initiative (CCI) edits, code 95832 (muscle testing, manual [separate procedure] with report; hand, with or without comparison with normal side) is not considered bundled into codes 95860-95870 (needle electromyography) or 95900-95904 (nerve conduction studies). It does state, however, that it is a separate procedure and can be billed so long as a separate report is created.
Technically, if a physician performs a neurology consult in the emergency room (ER) and admits the patient to the hospital, this service may be coded as either an initial patient consultation (99251-99255) or with initial hospital care codes (99221-99223). The emergency department physician probably will bill for an emergency department visit for the patients evaluation and management (E/M) services (99281-99285) leading up to the request for the neurologists consult, and the submission of code 99285 could cause concurrent care denials.
If the neurologist is performing and documenting a comprehensive history and exam, and medical decision- making of high complexity is involved, the choice would be between codes 99255 or 99223. If the medical decision-making is only of moderate complexity, the choice would be between 99254 or 99222. In either case, the consultation codes (99251-99255) pay more according to RBRVS values, so it is reasonable to bill for a consultation provided all three requirements of a consultation have been met: a documented request, indication of the advice or opinion sought by the emergency department physician, and a report of your opinion to the requesting physician.
The CPT definition of critical care codes 99291 and 99292 has changed as of Jan. 1, 2000. Previously, these codes were defined as care of the unstable critically ill or unstable critically injured patient who requires constant physician attendance. This was a very high threshold, and one that generally was not met by a great number of physicians billing critical care.
Since Jan. 1, the definition has been changed to refer to care of [...]
