Neurosurgery Coding Alert

Question: What is the best way to report transcranial motor evoked potentials for external anal and urethral sphincter muscle monitoring? Can we submit code 95870?

Nebraska Subscriber

Answer: CPT® does not offer any specific codes for transcranial motor evoked potential testing of the sphincter muscles. The code 95870 (Needle electromyography; limited study of muscles in 1 extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) might not be the best choice. Note that the code descriptor clearly states to not report 95870 for needle EMG of sphincter muscles.

Check for EMG: Check with the physician to learn whether he performed EMG testing of the anal/urethral sphincter muscles. The baseline intraoperative study typically is an EMG of either the rectal sphincter or urethra sphincter muscles rather than a motor evoked potential study. If so, you could report a choice from the 5178x code family, depending on whether the physician used a needle for the EMG testing.

Two possibilities include: 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) for non-needle EMG testing (often referred to as “sponge” electrode) or 51785 (Needle electromyography studies [EMG] of anal or urethral sphincter, any technique) for needle EMG.

What is needle electromyography? Needle electromyography (EMG) refers to the recording and study of the electrical activity of muscles using oscilloscope tracings and characteristic sounds produced by the electrical potentials. The physician makes recordings during needle insertion, with the muscle at rest, and during contraction. Needle EMG studies are interpreted in real time, as they are being performed.