Eli's Rehab Report

Separate Services May Warrant -59

"Some of these bundle combinations will be a big surprise to medical practices," says Heather Corcoran, coding manager at CGH Billing Services, a medical reimbursement consulting firm in Louisville, Ky. "The new edit bundling EMGs and nerve conduction studies into the chemodenervation codes seems to go against what some Medicare policies currently state."

What you'll face: National Heritage Insurance Company, a Part B carrier for five states, publishes a policy that says, "There may be patients who require electromyography in order to determine the proper injection site(s) for the use of medications such as botulinum toxin or other agents. The ICD-9-CM code 781.99 (Other symptoms involving nervous and musculoskeletal systems) should be used in these situations."

This policy was published before these NCCI edits took effect, however, so you should ask your carrier where it stands on reporting both services together.

Tip: You can use a modifier to separate the new bundled services if your documentation demonstrates that the services were distinct from one another, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. "I am not sure if the standard EMG service provided for location of the dystonic or spastic muscle would support the use of the -59 modifier (Distinct procedural service)," she says. "Certainly a diagnostic EMG performed separately at the same visit of the botulinum injection for medical reasons beyond injection site location would clearly support the use of the distinct-procedure modifier."

The catch: "The caveat," Hammer says, "is that the limited EMG code 95870 is not bundled with any of the chemodenervation codes. The vast majority of chemodenervation services do not require the complete requirements of a "full" extremity EMG testing. In my audits of the documentation of the botulinum injections, the more typical service provided and documented is the limited study."

Because the NCCI does not bundle the limited EMG study code 95870 into the Botox injection codes, you can still report these services together without appending a modifier.

Note: Visit www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.