Neurosurgery Coding Alert

Question: In the medical documentation, I 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, my provider also confirmed twitching of the finger in his right hand which was interfering with sleep and routine activities. My provider then requested electromyography (EMG) of the right upper extremity and cervical paraspinal area. Which CPT® code should I report?

Nebraska Subscriber

Answer: On the claim, you should report 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas) 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.

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. Other EMG choices include the following:

• 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).

EMG defined: Your provider will do an electromyogram (EMG) to measure the electrical activity n muscles. As a part of the procedure, your provider may do an EMG with muscles at rest as well as in activity.

According to Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington, the most common EMG scenario in many practices is testing for carpel tunnel syndrome (CTS). However, Bucknam reports that the provider might also use EMGs to help diagnose or determine the appropriate treatment for herniated discs, amyotrophic lateral sclerosis (ALS), myasthenia gravis (MG), weakness, paralysis, or muscle twitching.