Orthopedic Coding Alert

Coding changes completely when this test accompanies EMG.

Coding needle electromyographies (EMGs) on extremities can be tricky business; for basic needle EMGs, you’ll only need a single code.

However, if the orthopedist performs multiple studies/tests during the same session, you might have to completely change your coding strategy.

Confused? Don’t worry; we’ve got two experts at hand to run down all the extremity EMG issues you’re likely to face at your practice.

Choose Code After Extremity Count

When you are coding for a needle EMG of the extremities, you’ll first need to count the number of extremities the provider tested, confirms 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).

Needle EMGs Can Test, Monitor Several Conditions

Here’s just a few of the applications for EMG testing:

• Identifying neuromuscular diseases.
• Identifying motor control conditions.
• Guidance for muscle injections.
• Control signal for prosthetics — in the case of 95850-95864, that would mean hands, arms, feet, legs, etc.

Most common EMG uses: 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 “There are many conditions that are diagnosed or monitored using EMG. Probably the most common would be carpel tunnel syndrome, but any condition that is the result of nerve compression or where there is nerve demyelination might include an EMG.”

EMGs are also employed “to help diagnose or determine the appropriate treatment for herniated disc, amyotrophic lateral sclerosis [ALS], myasthenia gravis [MG], or to find the cause of weakness, paralysis, or muscle twitching,” she concludes.

Example: An avid tennis player presents to the provider complaining of shooting pain from the right side of his neck down his right arm, with some additional aching in his right elbow and some twitching of the finger in his right hand. This limits his activity and severely interrupts his sleep. After careful examination, the physician determines this this is likely related to his frequent tennis playing and may be tennis elbow or a shoulder injury. The physician orders an EMG of the right upper extremity and cervical paraspinal area. The testing neurologist’s interpretation confirms tennis elbow (lateral epicondylitis) of the right arm with no indication of cervical spine involvement.

For this encounter, Bucknam says you should report 95860 with M77.11 (Lateral epicondylitis, right elbow) appended to represent the patient’s injury. If the EMG occurs in a facility setting, append modifier 26 (Professional component) to 95860 to show you are only coding for the professional portion of the code. If the EMG occurs at your practice, leave modifier 26 off this claim.

Coding Changes When NCS Accompanies EMG

Providers often perform EMGs in tandem with nerve conduction studies (NCS) — so much so, in fact, that CPT^® has codes for the needle EMG/NCS combo.

When this occurs, how you code the EMGs changes. 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, confirms Falbo:

• +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)).

Bucknam says the tests are often paired because “the EMG determines whether there is a breakdown in the communication between the nerve and the muscles, and the nerve conduction study tests how long it takes the nerve signal to travel to its destination and cause a muscle response.”

Example: A patient presents with pain and numbness in both hands and wrists. He is a computer programmer and spends many hours a day using a mouse and keyboard, and the physician suspects a repetitive movement injury, likely carpel tunnel syndrome (CTS). The physician orders bilateral upper extremity EMG and NCS. Notes indicate that she performed five NCSs in each arm and also performed EMG in each arm. Interpretation of test results confirms bilateral mild CTS.

For this encounter, you’d report 95911 (Nerve conduction studies; 9-10 studies) for the NCS, and +95885 x 2 for the EMGs. Also, don’t forget to include ICD-10 code G56.03 (Carpal tunnel syndrome, bilateral upper limbs) to prove medical necessity for all the tests.

Expert: Combo Claims Often Flubbed

When discussing the EMG/NCS encounters, Bucknam says “one of the most frequent errors we see for billing these tests is that the provider just orders an EMG when both an EMG and NCS are needed; less frequently, we see only an NCS ordered when EMG is also needed.”

Physicians might think these orders mean that they might perform both tests when needed, “but that is not acceptable from a billing and reimbursement standpoint,” warns Bucknam. “If these codes are audited, the payer will expect to see an order for each test. If only an EMG is ordered, only an EMG can be performed.”