Neurosurgery Coding Alert

For EMG with 64612-64614 and 64640, stick with 95870 only

CMS has changed the rules for billing chemo-denervation injections with needle electromyography (EMG) guidance, so you should report only 95870 for EMG guidance with codes 64612-64614 and 64640.

National Correct Coding Initiative (NCCI) edits that went into affect April 1 limited the EMG codes that you could use with chemodenervation injections. And NCCI was scheduled to bundle the remaining EMG codes as of Jan. 1, 2005.

After hearing arguments made by the American Association of Electrodiagnostic Medicine (AAEM), however, CMS has agreed to allow physicians to bill limited EMG studies only for guidance during chemo-denervation, for a period of one year, while the agency and physician's organizations research other methods of assuring appropriate reimbursement.

Therefore, you should no longer report chemo-denervation (64612-64614, 64640) with needle EMG unless you use 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles or sphincters), says Tiffany Schmidt, JD, policy director for the AAEM.

As a future solution to this problem, CMS may allow for a new add-on code to describe needle EMG with chemodenervation. To do this, the AAEM advised CMS that it would need to go through the AMA's CPT process, which would take at least one year.

If CPT were to include a specific code to describe EMG guidance with chemodenervation, it would appear no sooner than 2006.