Neurosurgery Coding Alert

Key: Check extremity and any additional NCS services.

Your provider may often be doing electromyography (EMG) in routine practice but are you earning all you deserve for your services? Here is guidance on how to report EMG services. Next time you have a patient who suffered compressed nerves in an injury or developed demyelination and qualifies as a candidate for EMG, you can be sure you have correctly billed the services.

Step 1: Finding Codes for EMG Services

If your physician conducts an EMG for a patient, you’ll usually report a code from the following set, confirms Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa.:

• 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.

Key to right code: For the most appropriate EMG code, you need to check the procedure note to confirm if the procedure was done in one or both arms or legs.

Example: You may read that a patient who is recovering from a spinal injury sustained in a road traffic accident, presented with complains of shooting pain from the right side of his neck down his right arm. On interrogation, your provider also confirmed twitching of the finger in his right hand which was interfering with sleep and routine activities.

In this case, your provider may request an EMG of the right upper extremity and cervical paraspinal area. On the claim, you should report 95860 for the EMG. If your provider performed the test in a hospital setting, you would append modifier 26 (Professional component) to 95860 to show that you are only coding for the physician’s services, not the EMG equipment.

Step 2: NCS Necessitates EMG Add-On Code

There are times when your provider will perform a nerve conduction study (NCS) along with an EMG during the same encounter. Be on the lookout for EMG/NCS claims, as the two services often go together. When this occurs, you’ll choose one of the following codesfor the EMG, depending on encounter specifics:

• +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, … 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).
  

Remember: When you report an NCS along with an EMG, you code for the EMG with +95885 or +95886. The base code will be one of the NCS codes from the 95907 (Nerve conduction studies; 1-2 studies) through 95913 (… 13 or more studies) set.

Example: If you read that your provider did a NCS along with a complete EMG on a patient’s left arm, report 95907 for the NCS and +95886 for the EMG.