Outpatient Facility Coding Alert

Question: I know that the rectus abdominis muscle doesn’t fall under either the upper of lower extremity. That has me confused when I’m trying to determine whether a case involves three extremities – upper, lower, and trunk. The documentation is:

Spontaneous Electromyography (spEMG) – Lower Extremity/Trunk Bilateral
Rectus Abdominis, Iliopsoas, Quadriceps – Vastus Lateralis, Tibialis Anterior, Biceps FemorisAll Recordings Monitorable
Spontaneous Electromyography (spEMG) – Upper Extremity
Bilateral Deltoid, Biceps Brachii, Triceps, Thenar, Hypothenar
All Recordings Monitorable

Would you use CPT^® code 95863 in this situation? Thanks in advance for your help.

Missouri Subscriber

Answer: The rectus abdominis is an abdominal muscle, which means it would not be included in the EMG testing of the lower extremity muscles and related paraspinal muscles. According to CPT^® Assistant, 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) includes three different kinds of limited needle EMG studies, including, “Needle EMG of muscles on the thorax or abdomen. This is reported once, or one unit can be reported, regardless of whether it is a unilateral or bilateral study. …”

You should submit 95870 and append modifier 59 (Distinct procedural service) to differentiate it from 95863 (Needle electromyography; 3 extremities with or without related paraspinal areas) that would be reported for the EMG testing of the muscles of the three extremities.

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