Neurosurgery Coding Alert

Remember: CPT^® gives you very specific rules for how to report add-on codes +95885-+95887.

Reporting claims for needle electromyograms (EMGs) of the extremities can be challenging. First, you must know the number of extremities the provider tested. You must also check the documentation to see if the surgeon performed a combo EMG and nerve conduction study (NCS).

Read on to learn more.

Rely on These Needle EMG Codes of Extremities

During an EMG, the physician inserts a needle with wire electrodes through the skin, into the deeper layers, and then into the muscles. The provider monitors the electrical activity while he inserts the electrode into the muscles. Providers use EMGs to help diagnose or determine the appropriate treatment for radiculopathy related to disc problems, amyotrophic lateral sclerosis (ALS), myasthenia gravis (MG), weakness, paralysis, or muscle twitching.

When you are coding for a needle EMG of the extremities, you’ll first need to count the number of extremities the provider tested, says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. Once you get that count, choose from one of the following codes:

95860 (Needle electromyography; 1 extremity with or without related paraspinal areas)

• 95861 (… 2 extremities with or without related paraspinal areas)
• 95863 (… 3 extremities with or without related paraspinal areas)
• 95864 (… 4 extremities with or without related paraspinal areas)

Don’t miss: “Needle electromyographic (EMG) procedures include the interpretation of electrical waveforms measured by equipment that produces both visible and audible components of electrical signals recorded from the muscle(s) studied by the needle electrode,” according to the CPT^® guidelines.

Coding example: A patient is recovering from a spinal injury he sustained in a car accident. The patient presents with complaints of shooting pain from the right side of his neck and down his right arm. Upon exam, your neurosurgeon confirms twitching of the finger in the patient’s left hand, which has been interfering with his sleep and routine activities. The neurosurgeon requests an EMG of the patient’s right upper extremity and cervical paraspinal area. You should submit 95860 on your claim for the EMG. However, if the surgeon performs the test in a hospital, you should append modifier 26 (Professional component) to 95860 to show that you are only coding for the physician’s services, not the EMG equipment.

Don’t miss: There are some specific needle EMG codes for a few muscles that are not reported with the above codes, says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

These include anal/urethral sphincter (code 51785), larynx (code 95865), hemidiaphragm (code 95866) and extra-occular muscles (code 92265).

If a non-needle EMG is performed of the anal/urethral sphincter, you should report 51784 (Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique), Przybylski adds.

Correctly Report EMG/NCS Combo

Since physicians often perform EMGs in tandem with nerve conduction studies (NCS), CPT^® offers codes for the needle EMG/NCS combo. During an NCS, the physician measures the electrical conduction in a nerve. NCS is done in nerves that supply a muscle to assess whether transmission of the nervous signals to the muscles are adequate.

So, when the physician performs an EMG in conjunction with NCS on the same day, how you code the EMGs changes. In this case, the test is considered a secondary procedure to an NCS, so you’ll have to code the NCS first and then choose one of the following add-on codes for the needle EMG:

• +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))
• +95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; 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))
• +95887 (Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure))

Don’t miss: In this situation, the primary code on your claim will be one of the NCS codes from the 95907 (Nerve conduction studies; 1-2 studies) through 95913 (… 13 or more studies) set.

“Some payers will not cover a nerve conduction study without a concurrent EMG, except for a few diagnoses (eg. carpal tunnel syndrome),” Przybylski says. “Be sure to check coverage policies to determine the covered indications for these various tests.”

Heed Coding Rules for These Add-On Codes

CPT^® gives you very specific rules for how to appropriately report add-on codes +95885-+95887:

Rule 1: You should only report either +95885 or +95886 once per extremity. Additionally, you can report +95885 and +95886 “together up to a combined total of four units of service per patient when all four extremities are tested.”

Rule 2: You can report +95887 once per anatomic site. CPT^® gives several specific examples of anatomic sites — cervical paraspinal muscles, thoracic paraspinal muscles, lumbar paraspinal muscles, chest wall muscles, and abdominal wall muscles.

Rule 3: You should report +95887 for a unilateral study of the cranial nerve innervated muscles, not including the extra-ocular and the larynx. When the physician performs the service bilaterally, you may report +95887 twice.

Rule 4: You should report +95887 when the physician performs either a study of the cervical paraspinal muscles or a study of the lumbar paraspinal muscles with no corresponding limb study (codes +95885 or +95886) on the same day.