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Neurology & Pain Management Coding Alert

You Be the Coder:

Needle EMGs

Published on Sun Oct 01, 2000

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



Question: We bill CPT code 95860 together with A4215 for the actual needle. Although weve been paid for the needle as well as the needle EMG in the past, insurance companies lately tell us that these codes are bundled. Can we bill these charges separately?

South Dakota Subscriber


Answer: According to the current HCPCS manual, A4215 (needles only, sterile, any size, each) in combination with 95860 (needle electromyography [EMG], one extremity with or without related paraspinal areas) is not covered by or valid for Medicare or most third-party payers, says Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices. The Health Care Financing Administration (HCFA) considers billing A4215 in addition to code 95860 as unbundling the procedure because compensation for the needle is included in the payment amount for the needle EMG. Therefore, A4215 should not be billed separately.
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